Thursday May 29, 2008
Wellens syndrome (LAD coronary T-wave syndrome)

The EKG changes of Wellens syndrome can be easily recognized, many ED and ICU physicians are not aware of this. Wellens syndrome is associated with critical proximal left anterior descending artery lesion. These patients are at very high risk and immediate catheterization is recommended. The EKG pattern of the T-wave changes present in the mid-precordial leads characterized by either

• deeply symmetric inverted T-waves (Type 1 Wellen) or
• biphasic T-waves (Type 2 Wellen)

See ppt. presentation 12 Lead Basics Wellens Syndrome


These are mostly read as non specific T wave abnormalities as mostly these EKG changes appear during pain free period of Angina.

The cardiac enzymes are generally negative. The excercise stress test can provocate acute infarction. Most of these patients will develop anterior wall MI within a few weeks. Cardiac catheterization is indicated in these patients.


Read here case report with discussion (pdf) on Wellens Syndrome
(Ayman A. Elmenyar, MBBch, Msc., HEART VIEWS VOL. 1 NO. 10 DECEMBER 2000- FEBRUARY 2001: 408-410)

See here very good power point presentation including EKGs
(slide 1 to 30 is Wellens Syndome) - Francis Mencl MD, MS, FACEP



Reference: Click to article

1. Ayman A. Elmenyar: Electrocardiographic Diagnosis Of Critical Left Coronary Arterial System Stenosis: The Internet Journal of Cardiology. 2004; Volume 2, Number 2.

2. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med. 2002 Nov;20(7):638-43.