Diagnostics
Electrocardiographic manifestations of Wellens' syndrome*,**,†

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Abstract

Wellens' syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending (LAD) artery stenosis. The syndrome is also referred to as LAD coronary T-wave syndrome. Syndrome criteria include T-wave changes plus a history of anginal chest pain without serum marker abnormalities; patients lack Q waves and significant ST-segment elevation; such patients show normal precordial R-wave progression. The natural history of Wellens' syndrome is anterior wall acute myocardial infarction. The T-wave abnormalities are persistent and may remain in place for hours to weeks; the clinician likely will encounter these changes in the sensation-free patient. With definitive management of the stenosis, the changes resolve with normalization of the electrocardiogram. It is vital that the physician recognize these changes and the association with critical LAD obstruction and significant risk for anterior wall myocardial infarction. (Am J Emerg Med 2002;20:638-643. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Section snippets

Case 1

A 49-year-old man presented to the ED with chest pain of 4 hours' duration that was associated with diaphoresis. Emergency medical technicians treated the patient with nitrates, morphine, and aspirin; he was sensation-free on arrival to the ED. The examination was unremarkable. The 12-lead ECG (Fig 1), performed when the patient was free of discomfort, showed deeply inverted T waves in leads V2 to V6; the ST segments were minimally elevated and convex in morphology in leads V2 to V4.

. Case 1,

Discussion

de Zwann et al1 first described a subgroup of patients hospitalized for unstable angina that were at high risk for the development of an anterior wall myocardial infarction. This subgroup could be recognized by characteristic ST-segment-T-wave changes in the precordial leads. These changes involve the T wave with occasional involvement of the ST segment. Two basic patterns of electrocardiographic change are encountered: (1) isoelectric or minimally elevated (ie, less than 1 mm) ST segment with

Conclusion

Wellens' syndrome is a preinfarction stage of coronary artery disease. Patients with this syndrome present with characteristic electrocardiographic findings in the precordial leads. These changes are associated with obstruction in the proximal LAD coronary artery. Two patterns of electrocardiographic changes are encountered, the deeply inverted T wave and the biphasic T wave. Once Wellens' syndrome has been recognized, cardiology consultation for possible coronary angiography is likely

References (8)

  • TK Tandy et al.

    Wellens' Syndrome

    Ann Emerg Med

    (1999)
  • AD Perron et al.

    Electrocardiographic manifestations of CNS events

    Am J Emerg Med

    (2000)
  • C de Zwann et al.

    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)
  • C de Zwann et al.

    Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery

    Am Heart J

    (1989)
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Address correspondence to William Brady, MD, Department of Emergency Medicine, Box 523-21, University of Virginia Medical Center, Charlottesville, VA 22908. E-mail: [email protected]

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