Wellens Syndrome

Thanks to Dr. Kincade for today’s Morning Report!

Wellens Syndrome

• Pattern of inverted or biphasic T waves in precordial leads that are specific for critical LAD stenosis
• Critical stenosis LAD
• High risk of anterior MI w/o medical tx: 75% pt advance to ant MI in avg 8.5 days if only medically tx w/o PCI

***DO NOT SEND PT FOR STRESS TESTING

Criteria for Dx:

• Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6)
• Inverted T waves 76% biphasic T waves 24%
• Isoelectric or minimally-elevated ST segment (< 1mm)
• No precordial Q waves
• Preserved pericardial R wave progression (R wave > 3 small boxes tall DePace criteria)
• Recent history of angina
• ECG pattern present in pain-free state
• Normal or slightly elevated serum cardiac markers

References:

• De Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982;103(4 Pt 2):730-6.
• Rhinehardt J, Brady WJ, Perron AD et al. Electrocardiographic manifestations of Wellens’ syndrome. Am J Emerg Med 2002; 20: 638-43.

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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