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.

TYPE B: 76% of the time, deep inversion of the T-wave segment in the precordial leads, V1-V4.

Key Treatment Points

• Patient advocacy for a cardiology consult
• Monitor for potential emerging STEMI

12 Lead ECG Samples

TYPE A

TYPE B

Further Reading

References

1. Rhinehardt J, et al. Electrocardiographic manifestations of Wellens’ syndrome. 2002. [Link]