Wellens' syndrome - Revision history

Benalexander: /* External Links */

2025-09-16T15:48:54Z

External Links

← Older revision		Revision as of 15:48, 16 September 2025
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	==External Links==		==External Links==
	[https://litfl.com/wellens-syndrome-ecg-library/]		[https://litfl.com/wellens-syndrome-ecg-library/ LIFTL - Wellens Syndrome]

	==References==		==References==

Benalexander: /* External Links */ Replaced broken youtube link.

2025-09-16T15:47:21Z

External Links: Replaced broken youtube link.

← Older revision		Revision as of 15:47, 16 September 2025
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	==External Links==		==External Links==
	[https://~~www.youtube~~.com/~~watch?v=RdnwIWu5HHg Mattu ECG Case~~ - ~~Wellens' Syndrome~~]		[https://litfl.com/wellens-syndrome-ecg-library/]

	==References==		==References==

Rossdonaldson1: /* Video */

2024-04-17T20:12:07Z

Video

← Older revision		Revision as of 20:12, 17 April 2024
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	==External Links==		==External Links==
	[https://www.youtube.com/watch?v=RdnwIWu5HHg Mattu ECG Case - Wellens' Syndrome]		[https://www.youtube.com/watch?v=RdnwIWu5HHg Mattu ECG Case - Wellens' Syndrome]

	~~==Video==~~
	~~{{#widget:YouTube\|id=SgTJYu8b6dE}}~~

	==References==		==References==

Rossdonaldson1: /* Management */

2023-09-20T16:38:53Z

Management

← Older revision		Revision as of 16:38, 20 September 2023
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	==Management==		==Management==
	*Treat similarly to MI, including antiplatelets and anticoagulation<ref>Miner B, Grigg WS, Hart EH. Wellens Syndrome. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.</ref>		*Treat similarly to MI, including antiplatelets and anticoagulation<ref>Miner B, Grigg WS, Hart EH. Wellens Syndrome. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.</ref>
	*Urgent cardiac catheterization is the ~~definite~~ treatment		*Urgent cardiac catheterization is the definitive treatment
	*Stress testing contraindicated		*Stress testing contraindicated
	**Can precipitate an acute myocardial infarction and sudden death		**Can precipitate an acute myocardial infarction and sudden death

Patricklin at 20:19, 17 September 2023

2023-09-17T20:19:27Z

← Older revision		Revision as of 20:19, 17 September 2023
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	==Background==		==Background==
	*First described in 1982		*First described in 1982, a set of EKG changes specific for critical, proximal stenosis of LAD
	**Subset of ~~patients fared poorly with medical management~~ of ~~“impending myocardial infarction” ([[unstable angina]])~~		**At risk for extensive anterior wall myocardial infarction due to proximal LAD stenosis<ref>de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4 Pt 2):730-736.</ref>
	***At risk for extensive anterior wall myocardial infarction due to proximal LAD stenosis<ref>de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4 Pt 2):730-736.</ref>		***In the original study, a subset of patients fared poorly with medical management of “impending myocardial infarction”
	***~~Shared characteristic ECG changes~~		***75% of patients with these findings will later develop anterior MI (if not treated with PCI)
	****T wave abnormality associated with ~~critical LAD~~ stenosis<ref>Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. American Journal of Emergency Medicine. 2002;20(7):638-643. doi:10.1053/ajem.2002.34800.</ref>		**Characteristic EKG changes: T wave abnormality (2 types, shown below) associated with the stenosis<ref>Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. American Journal of Emergency Medicine. 2002;20(7):638-643. doi:10.1053/ajem.2002.34800.</ref>
	**~~Findings can be transient (persists for hours after pain has resolved and then disappears)~~		*Commonly described as a STEMI equivalent, but per the 2022 ACC Expert Consensus Decision Pathway, it's instead categorized as an ischemic change<ref>2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee, Journal of the American College of Cardiology, Volume 80, Issue 20,2022,Pages 1925-1960,ISSN 0735-1097.</ref>
			**This is because patient is not currently having an MI; rather, it's a post-ischemic change

	==Clinical Features==		==Clinical Features==
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	*Isoelectric or <1mm [[ST elevation\|ST-segment elevation]]		*Isoelectric or <1mm [[ST elevation\|ST-segment elevation]]
	*Wellens' sign present in pain-free state		*Wellens' sign present in pain-free state
	**Wellens' sign during pain free state plus recent history of angina and normal to slightly elevated [[cardiac enzymes]] = Wellen's syndrome		**Wellens' sign during pain-free state plus recent history of angina and normal to slightly elevated [[cardiac enzymes]] = Wellen's syndrome
			**Findings can be transient (persists for hours after pain has resolved and then disappears)

	Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):		===Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):===
	*Type A (25%)		*Type A (25%)
	**Biphasic T-wave in V2/V3		**Biphasic T-wave in V2/V3
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	[[Image:Wellens.png]]		[[Image:Wellens.png]]
			*IF there is acute occlusion MI, Wellens T wave patterns may normalize and convert to ST elevations
	''Note Wellens criteria should not be applied to patients with [[LVH]]''		*Note Wellens criteria should not be applied to patients with [[LVH]]

	==Management==		==Management==
	*Urgent cardiac catheterization		*Treat similarly to MI, including antiplatelets and anticoagulation<ref>Miner B, Grigg WS, Hart EH. Wellens Syndrome. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.</ref>
			*Urgent cardiac catheterization is the definite treatment
	*Stress testing contraindicated		*Stress testing contraindicated
			**Can precipitate an acute myocardial infarction and sudden death

	==Disposition==		==Disposition==

Elcatracho: /* Evaluation */

2021-02-05T03:06:09Z

Evaluation

← Older revision		Revision as of 03:06, 5 February 2021
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	==Evaluation==		==Evaluation==
	*History of [[chest pain]]		*History of [[chest pain]]
			**[[ECG]] may be normal during episode of pain
	*Normal or slightly-elevated [[cardiac enzymes]]		*Normal or slightly-elevated [[cardiac enzymes]]
	*No precordial Q-waves		*No precordial Q-waves
	*Isoelectric or <1mm [[ST elevation\|ST-segment elevation]]		*Isoelectric or <1mm [[ST elevation\|ST-segment elevation]]
	*Wellens' ~~pattern~~ present in pain-free state		*Wellens' sign present in pain-free state
			**Wellens' sign during pain free state plus recent history of angina and normal to slightly elevated [[cardiac enzymes]] = Wellen's syndrome

	Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):		Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):

ClaireLewis at 19:06, 26 September 2019

2019-09-26T19:06:20Z

← Older revision		Revision as of 19:06, 26 September 2019
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	*Symptoms of [[Myocardial infarction]] or ischemia		*Symptoms of [[Myocardial infarction]] or ischemia
	*Symptoms have often resolved at presentation		*Symptoms have often resolved at presentation
	*May have previous recent episodes of angina or anginal equivalents		*May have previous recent episodes of [[angina]] or anginal equivalents
	*Initial cardiac enzymes are frequently normal or slightly elevated<ref>Ünlüer EE et al. Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1. West J Emerg Med. 2012 May; 13(2): 160–162.</ref><ref>Kannan L and Figueredo VM. Wellens' Syndrome. Jan 1, 2015. N Engl J Med 372;1.</ref>		*Initial cardiac enzymes are frequently normal or slightly elevated<ref>Ünlüer EE et al. Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1. West J Emerg Med. 2012 May; 13(2): 160–162.</ref><ref>Kannan L and Figueredo VM. Wellens' Syndrome. Jan 1, 2015. N Engl J Med 372;1.</ref>
	*[[Cocaine]] use may cause pseudo-Wellens due to vasospasm without critical stenosis<ref>Dhawan SS. Pseudo-Wellens’ syndrome after crack cocaine use. Can J Cardiol. 2008; 24(5):404.</ref>		*[[Cocaine]] use may cause pseudo-Wellens due to vasospasm without critical stenosis<ref>Dhawan SS. Pseudo-Wellens’ syndrome after crack cocaine use. Can J Cardiol. 2008; 24(5):404.</ref>
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	*[[ECG (Basics)\|RBBB]]		*[[ECG (Basics)\|RBBB]]
	*[[Hypokalemia]]		*[[Hypokalemia]]
	*CNS Injury		*[[head injury\|CNS Injury]]
	*Persistent Juvenile T-wave pattern		*Persistent Juvenile T-wave pattern
	*[[Digitalis Effect]]		*[[Digitalis Effect]]
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	==Evaluation==		==Evaluation==
	*History of chest pain		*History of [[chest pain]]
	*Normal or slightly-elevated cardiac enzymes		*Normal or slightly-elevated [[cardiac enzymes]]
	*No precordial Q-waves		*No precordial Q-waves
	*Isoelectric or <1mm ST-segment elevation		*Isoelectric or <1mm [[ST elevation\|ST-segment elevation]]
	*Wellens' pattern present in pain-free state		*Wellens' pattern present in pain-free state

SLuckettG: /* Evaluation */

2019-03-18T20:32:43Z

Evaluation

← Older revision		Revision as of 20:32, 18 March 2019
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	==Evaluation==		==Evaluation==
	#History of chest pain		*History of chest pain
	#Normal or slightly-elevated cardiac enzymes		*Normal or slightly-elevated cardiac enzymes
	#No precordial Q-waves		*No precordial Q-waves
	#Isoelectric or <1mm ST-segment elevation		*Isoelectric or <1mm ST-segment elevation
	~~#Pattern~~ present in pain-free state		*Wellens' pattern present in pain-free state

	Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):		Two T-wave Characteristics (at times terms are reversed in the literature or labeled Type I and II):
	*Type A (25%): Biphasic T-wave in V2/V3		*Type A (25%)
	*Type B (75%): Deep, symmetrically inverted T-waves in V2/V3		**Biphasic T-wave in V2/V3
			*Type B (75%)
			**Deep, symmetrically inverted T-waves in V2/V3

	[[Image:Wellens.png]]		[[Image:Wellens.png]]

	''Note Wellens criteria should not be ~~diagnosed in a patetient~~ with LVH.;''		''Note Wellens criteria should not be applied to patients with [[LVH]]''

	==Management==		==Management==

SLuckettG: /* Clinical Features */

2019-03-18T20:27:59Z

Clinical Features

← Older revision		Revision as of 20:27, 18 March 2019
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	==Clinical Features==		==Clinical Features==
	~~Refer to~~ [[Myocardial infarction]]		*Symptoms of [[Myocardial infarction]] or ischemia
	*~~May be pain free~~ at presentation ~~and time of ECG~~		*Symptoms have often resolved at presentation
	*May have ~~had~~ previous recent ~~episode~~ of angina ~~+/- associated symptoms~~		*May have previous recent episodes of angina or anginal equivalents
	*Initial cardiac enzymes are frequently normal or ~~only~~ slightly elevated<ref>Ünlüer EE et al. Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1. West J Emerg Med. 2012 May; 13(2): 160–162.</ref><ref>Kannan L and Figueredo VM. Wellens' Syndrome. Jan 1, 2015. N Engl J Med 372;1.</ref>		*Initial cardiac enzymes are frequently normal or slightly elevated<ref>Ünlüer EE et al. Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1. West J Emerg Med. 2012 May; 13(2): 160–162.</ref><ref>Kannan L and Figueredo VM. Wellens' Syndrome. Jan 1, 2015. N Engl J Med 372;1.</ref>
	*[[Cocaine]] may cause pseudo-Wellens due to vasospasm without critical stenosis<ref>Dhawan SS. Pseudo-Wellens’ syndrome after crack cocaine use. Can J Cardiol. 2008; 24(5):404.</ref>		*[[Cocaine]] use may cause pseudo-Wellens due to vasospasm without critical stenosis<ref>Dhawan SS. Pseudo-Wellens’ syndrome after crack cocaine use. Can J Cardiol. 2008; 24(5):404.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

SLuckettG: /* Background */

2019-03-18T20:26:39Z

Background

← Older revision		Revision as of 20:26, 18 March 2019
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	==Background==		==Background==
	~~Initially~~ described in 1982 ~~where a subset~~ of patients ~~who did~~ poorly with medical management of “impending myocardial infarction” (~~essentialy~~ unstable angina) ~~were found to have characteristic ECG changes. These patients were noted to be at increased~~ risk for extensive anterior wall myocardial ~~infarctions~~ due to proximal LAD stenosis.<ref>de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4 Pt 2):730-736.</ref>		*First described in 1982
			**Subset of patients fared poorly with medical management of “impending myocardial infarction” ([[unstable angina]])
	*T wave abnormality ~~that is~~ associated with critical LAD stenosis<ref>Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. American Journal of Emergency Medicine. 2002;20(7):638-643. doi:10.1053/ajem.2002.34800.</ref>		***At risk for extensive anterior wall myocardial infarction due to proximal LAD stenosis<ref>de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4 Pt 2):730-736.</ref>
	**~~Finding~~ can be transient (persists for hours after pain has resolved and then disappears)		***Shared characteristic ECG changes
	**Preinfarction stage of CAD		****T wave abnormality associated with critical LAD stenosis<ref>Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. American Journal of Emergency Medicine. 2002;20(7):638-643. doi:10.1053/ajem.2002.34800.</ref>
	*Natural history may include progression to extensive anterior wall myocardial infarction, often associated with severe left ventricular systolic dysfunction, cardiogenic shock and even death		**Findings can be transient (persists for hours after pain has resolved and then disappears)

	==Clinical Features==		==Clinical Features==