- 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%
- 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
- 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
- Non-Q-wave & Q-wave infarcts
- Wolff-Parkinson-White syndrome
- Pulmonary embolism
- Left ventricular hypertrophy