Wellens' syndrome
Background
- T wave abnormality that is associated with critical LAD stenosis
- Finding can be transient (persists for hours after pain has resolved and then disappears)
- Preinfarction stage of CAD, and heralds extensive anterior wall MI
Criteria
- Biphasic T waves in leads V2-V3 OR symmetric, often deeply inverted T waves in V2-V3
- Prior history of chest pain (CP resolved)
- Little or no cardiac enzyme elevation
- No pathologic precordial Q waves
- Little or no ST-segment elevation
- No loss of precordial R waves
Two T-wave Characteristics:
- Type A: Inversion pattern - 75% - Deeply inverted and symmetric T-waves seen in EKG B
- Type B: Biphasic pattern - 25% - Biphasic T-waves (initial + deflection and terminal - deflection) seen in EKG A
Note Wellens criteria should not be diagnosed in a patetient with LVH.
Mimics
- High voltage
- PE
- RBBB
- Hypokalemia
- CNS Injury
- Persistent Juvenile T-wave pattern
- Digitalis effect
Treatment
- Urgent cardiac catheterization
Stress testing contraindicated, may prove fatal
Source
Wellens’ Syndrome. Annals of Emergency Medicine, March, 1999