The syndrome is also referred to as lad coronary twave syndrome. A 31yearold male smoker with diabetes mellitus presented with intermittent, exertional chest pain. Electrocardiographic manifestations of wellens syndrome. Wellens syndrome is a pattern of deeply inverted or biphasic t waves in v23, which is highly specific for a critical stenosis of the left anterior descending artery lad patients may be pain free by the time the ecg is taken and have normally or minimally elevated cardiac enzymes. Syndrome criteria include twave changes plus a history of anginal chest pain without serum marker. Wellens syndrome is a pattern of electrocardiographic twave changes associated with critical, proximal left anterior descending lad artery. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Wellens syndrome is an important diagnosis to consider in a patient with t wave inversions or biphasic t waves and negative cardiac markers. Wellens syndrome in an elderly patient with dementia wellens syndrome in an elderly patient with dementia. Subtotal occlusion of the proximal left anterior descending is present. Although these patients may be stable and pain free throughout their stay within the emergency room, a large number of patients will go on to experience anterior myocardial infarctions. Serdar ozdemir, tuba cimilli ozturk, yalman eyinc, ozge ecmel onur, muhammed keskin turkish journal of emergency medicine 2015, 15 4. Wellens syndrome the american journal of emergency medicine. Rapid progression of wellens syndrome in the emergency.
Wellens syndrome litfl medical blog ecg library eponym. However, wellens syndrome can also present as biphasic twave inversions in those same ecg leads. Wellens syndrome was divided into two variant based on ecg finding, type a was biphasic twave inversion and type b was deep t wave inversion in precordial lead v1 or v2 until v4 or v5 figure 4. Early cardiology consultation is prudent as urgent percutaneous intervention or coronary artery bypass grafting are treatment modalities of choice. The ecg findings in wellens syndrome including biphasic or inverted t waves is discussed with 12lead ecg examples. The associated critical stenosis of the proximal left anterior. Wellens syndrome describes a pattern of electrocardiographic ecg. Type a is characterized by biphasic t wave in leads v2 and v3, whereas.
Wellens syndrome is a pattern of electrocardiographic twave changes associated with critical, proximal left anterior descending lad artery stenosis. He gave no history of being a diabetic, hypertensive or being on treatment for a cardiac illness. Wellens syndrome consists of particular twave changes in the precordial leads of an electrocardiogram ecg accompanied by proximal. Wellens syndrome is a pattern of twave changes seen in the anterior leads on an ekg that is highly specific for critical stenosis of the left anterior descending lad coronary artery. There is a family history of coronary artery disease. Definitive treatment typically involves cardiac catheterization with. It is virtually pathognomonic for significant stenosis of the proximal left anterior descending coronary artery lad. Seven years later, the same authors performed another prospective study on patients with wellens syndrome and confirmed 100% association with a significant proximal lad disease by cardiac coronary angiography. The distinct ecg patterns of wellens syndrome, indicating myocardial ischemic disease caused by critical proximal left anterior descending lad stenosis, could.