Lightning Learning: Wellens Syndrome

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STOP!

Wellens syndrome describes a pattern of deeply inverted or biphasic T-waves in V2 and V3 → this is highly specific for a critical stenosis of the Left Anterior Descending Artery (LAD).

Symptoms

• Maybe pain free at time when initial ECG is taken

• May have normally or minimally elevated cardiac enzymes

• At extremely high risk for extensive anterior wall MI within the next few days to week

Treatment

• Analgesia as required

• Serial ECGs

• Require urgent cardiology review

LOOK

There are TWO ECG pattern types…

Type A: Biphasic with initial positivity and terminal negativity (25% of cases)

Type A (V2)

Type A (V3)

Type B: Deeply and symmetrically inverted (75% of cases)

Type B (V2)

Type B (V3)

LEARN

1. The ECG in Acute MI (S. Smith, A. Zvosec, S. Sharkey, T. Henry)
2. Wellens syndrome ECG library (LITFL)
3. 12-lead ST segment monitoring in Wellens' syndrome (Dr Smith’s ECG Blog)