Wellens' syndrome


  • 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%
Wellen syndrome
ECG - Thanks to Life in the Fast Lane


  • 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

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.

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

Differential Dx T-wave inversion

  • Myocarditis
  • Stroke
  • Digitalis

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 11/04/23.