Wellens' syndrome

Revision as of 04:52, 6 August 2016 by Kxl328 (talk | contribs)

Background

  • T wave abnormality that is associated with critical LAD stenosis
    • Finding can be transient (persists for hours after pain has resolved and then disappears)
    • Preinfarction stage of ACS and heralds extensive anterior wall MI

Clinical Features

Refer to Myocardial infarction

  • May be pain free at presentation and time of ECG
  • May have had previous recent episode of angina +/- associated symptoms
  • Initial cardiac enzymes are frequently normal or only slightly elevated[1][2]
  • Cocaine may cause pseudo-Wellens due to vasospasm without critical stenosis[3]

Differential Diagnosis

  • High voltage
  • PE
  • RBBB
  • Hypokalemia
  • CNS Injury
  • Persistent Juvenile T-wave pattern
  • Digitalis Effect
  • "Normal variant" STE with biphasic T-wave[4]
    • Common in young, healthy, black males
    • Patterns that are NOT found in Wellen's
      • High voltage complexes
      • Notching at J-point ("fishhook")
      • Concave upward ST segment followed by steep drop in T wave

ST Elevation

Evaluation

  1. Biphasic T waves in leads V2-V3 OR symmetric, often deeply inverted T waves in V2-V3
  2. Prior history of chest pain (chest pain resolved)
  3. Little or no cardiac enzyme elevation
  4. No pathologic precordial Q waves
  5. Little or no ST-segment elevation
  6. No loss of precordial R waves

Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):

  • Type A: Biphasic pattern - 25% - Biphasic T-waves (initial + deflection and terminal - deflection)
  • Type B: Inversion pattern - 75% - Deeply inverted and symmetric T-waves

Wellens.jpg

Note Wellens criteria should not be diagnosed in a patetient with LVH. 

Management

  • Urgent cardiac catheterization

See Also

External Links

Mattu ECG Case - Wellens' Syndrome

Video

References

  1. Ünlüer EE et al. Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1. West J Emerg Med. 2012 May; 13(2): 160–162.
  2. Kannan L and Figueredo VM. Wellens' Syndrome. Jan 1, 2015. N Engl J Med 372;1.
  3. Dhawan SS. Pseudo-Wellens’ syndrome after crack cocaine use. Can J Cardiol. 2008; 24(5):404.
  4. Wang, et al. ST-segment elevation in conditions other than acute myocardial infarction. NEJM 2003, 349:2128-2135.