Wellens' syndrome

Background

Wellen syndrome
ECG - Thanks to Life in the Fast Lane
  • ECG pattern of T-waves in pre-cordial leads associated with critical stenosis of LAD.
  • T-wave changes usually during pain free period.
  • In 1982 - Wellen’s reviewed ECG’s of 145 unstable angina patients.
    • 18% showed ECG pattern (1/2 at presentation, 1/2 within 24 hours),   75% later developed anterior AMI.
  • Two types ECG pattern:
    • Biphasic T-waves in V2 (occasionally V3) - 25% of cases.
    • Deep symmetrically inverted T-waves in V2 and V3, occasionally all V leads - 75% of cases.

Criteria

  • No cardiac enzyme elevation.
  • No pathology pre-cordial Q waves.
  • No ST elevation.
  • No loss of pre-cordial R-waves.
  • Biphasic T-waves in leads V2 and V3.

Please complete brief neurological examination to exclude SAH or focal neurological event. (ECG changes)

In Wellen’s’ study almost all had critical stenosis of the L.A.D.

Exercise stress testing is contraindicated in cases of suspected left main stem stenosis.
Initial T-wave changes may be transient or persist for many months after angioplasty.

Differential Dx T-wave inversion

  • Non-Q-wave & Q-wave infarcts.
  • Wolff-Parkinson-White syndrome.
  • Pulmonary embolism.
  • Left ventricular hypertrophy.
  • Myocarditis.
  • Stroke.
  • Digitalis.

Content by Dr Íomhar O' Sullivan 16/10/2002.   Reviewed by Dr ÍOS 14/10/2004, 18/07/2005, 27/03/2007. Last review Dr. ÍOS 5/05/15