Wellens Syndrome

Definition

Pre-infarction stage of coronary artery disease suggesting 80-90% LAD occlusion that often progresses to a devastating anterior wall MI. 

History/Physical Exam

Following an ischemic event suggestive of unstable angina.  ECG findings are generally only visible once patient is pain free.

Key 12-Lead Features

TYPE A: Biphasic T waves, most commonly in leads V2 and V3.  Presents with upstroke/down-stroke.  Approximately 25% of the time.

TYPE B: Deep inversion of the T-wave segment in the precordial leads, V1-V4.  Approximately 75% of the time.

Key Treatment Points

Patient advocacy for a cardiology consult

Monitor for potential emerging STEMI

12 Lead ECG Samples

Further Reading

References

Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens’ syndrome. Am J Emerg Med. 2002 Nov;20(7):638-43. PubMed PMID: 12442245.