Mattu, electrocardiographic manifestations of wellens syndrome, the american journal of emergency medicine, vol. Wellens syndrome refers to these specific electrocardiographic ecg abno. Cases can be classified according to the ecg pattern into type 1 biphasic t waves or type 2 deeply inverted t waves, especially in leads v2 and v3. Harbinger of infarction wellens syndrome electrocardiographic abnormalities in the emergency department. In wellens study, 60% of patients diagnosed with wellens syndrome had the characteristic electrocardiographic changes on admission. Approximately 75% of patients with wellens syndrome who are only medically managed and not revascularised either through coronary bypass surgery or angioplasty go on to develop extensive anterior wall infarction within days. Syndrome criteria include twave changes plus a history. Diagnostic criteria of wellens syndrome are history of chest pain, little or no cardiac enzyme elevation, little or no stsegment elevation, no loss of precordial r waves, no pathologic. Apicobasal gradient of left ventricular myocardial edema.
Patients may be pain free by the time the ecg is taken and have normally or minimally elevated cardiac enzymes. Originally thought of as two separate presentations, a and b, it is now considered an evolving wave form, initially of biphasic t wave inversions and later becoming symmetrical, often deep 2 mm, t wave. As the authors have mentioned these twave changes are seen in the patients ekg while the patient is asymptomatic, painfree. In face of the clinical and laboratory manifestations and typical. Electrocardiographic changes in wellens syndrome are subtle and characteristically appear during chest pain free interval.
Type a wellens syndrome is characterized by progressive deep twave inversions in precordial. Very few cases of wellens syndrome in hiv positive patients have been reported. Clinical and electrocardiographic criteria for wellens pattern. Clinical significance of inverted twaves during the acute phase of myocardial infarction in patients with myocardial reperfusion. Electrocardiographic findings of wellens syndrome due to coronary arterypulmonary artery fistula dongfeng wu, yinxiong wu and jinlong deng abstract a coronary artery fistula caf is an abnormal connection between a coronary artery and any of the fourcardiac chambers, the large vessels, orother vascular structures.
Biphasic or deeply inverted twaves in leads v 2 v 3 but sometimes found in leads v 1 and v 4 v 6 minimal or no stsegment elevation wellens hj. Ecg was then repeated figure 1 and showed biphasic t waves in leads v1 to v4. These patients had distinctive ecg findings, including deep symmetric twave inversion or biphasic t waves in the anterior precordial leads, stsegment. Wellens syndrome is an electrocardiographic ecg pattern involving t waves in. These patients had distinctive ecg findings, including deep symmetric twave inversion or biphasic t waves in the anterior precordial leads. Wellens syndrome is an electrocardiographic ecg pattern involving t waves in precordial leads that was first described in 1982 among a group of patients presenting with unstable angina suggestive of critical stenosis of the proximal left anterior descending lad coronary.
Pdf an incidental case of wellens syndrome in a community. Recognizing wellens syndrome, a warning sign of critical proximal lad artery stenosis and impending anterior myocardial infarction. Syndrome criteria include twave changes plus a history of anginal chest pain without serum marker. Wellens syndrome, also called left anterior descending lad coronary twave syndrome, is a characteristic electrocardiographic ecg pattern suggestive of coronary artery disease in the preinfarction stage. The syndrome is also referred to as lad coronary twave syndrome. Pitfalls in electrocardiographic diagnosis of acute.
Electrocardiographic changes in asymptomatic individuals may be a diagnostic challenge. We report a case of type a wellens syndrome with subtle t wave changes that. Pdf wellens syndrome, an electrocardiographic warning sign. The wellens pattern is an electrocardiographic ecg finding that represents critical proximal left anterior descending lad coronary artery stenosis that, that when is not promptly treated, can lead to extensive anterior wall myocardial infarction and death. Here, we are describing a case of middle aged male patient presented with history of typical chest pain with slightly elevated blood pressure bp with an initial ecg showing brugada pattern, patient was admitted and started with. Wellens syndrome is an electrocardiographic manifestation of critical proximal left anterior descending lad coronary artery stenosis in patients with unstable angina. This case report presents the electrocardiographic findings of a man in his 70s with wellens syndrome. Wellens syndrome is a pattern of deeply inverted or biphasic t waves in v23, which is highly specific for a critical stenosis of the left anterior descending artery lad. These patients had distinctive ecg findings, including deep symmetric twave inversion or biphasic t waves in the anterior precordial leads, stsegment changes elevation or depression. Twave changes in wellens syndrome are typically observed in asymptomatic patients. Wellens syndrome is a pattern of electrocardiographic twave changes associated with critical, proximal left anterior descending lad artery. The pattern may manifest itself persistently over a period of weeks, and its natural history is an imminent anterior wall acute myocardial infarction. The knowledge and early identification of these patterns and their correct association with clinical picture shall have an urgent and specific management. The authors present a case of wellen s syndrome, which has a characteristic twave on an electrocardiogram during a painfree period in a patient with intermittent chest pain.
Wellens syndrome is a pattern of electrocardiographic twave changes associated with critical, proximal left anterior descending lad artery stenosis. Electrocardiographic manifestations of wellens syndrome article in american journal of emergency medicine 207. Electrocardiographic findings the authors 2020 of wellens. The characteristic ecg pattern of wellens syndrome is relatively common in patients who have symptoms consistent with unstable angina. Rhinehardt j, brady wj, perron ad, mattu a 2002 electrocardiographic manifestations of wellens syndrome. Wellens syndrome is an uncommon perioperative occurrence. Electrocardiogram patterns that clinicians should be aware of yin. A, baseline ecg shows wellens t waves in leads v 2 and v 3. Wellens syndrome consists of twave abnormalities in the anterior chest leads. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Wellens syndrome, also known as lad coronary twave inversion syndrome, is a characteristic ecg pattern that highly suggests critical stenosis of the proximal left anterior descending lad coronary artery. Wellens syndrome includes a specific pattern of twave changes in the ecg during painfree status in patients with intermittent angina chest pain. The pattern of clinical findings and electrocardiography ecg changes known as wellens syndrome is associated with significant stenosis of the proximal left anterior descending coronary artery. Among the many electrocardiographic findings indicative of acute coronary syndromes, the ep must be familiar with the characteristics of the preinfarction stage of coronary artery disease known as wellens syndrome.
A 75yearold caucasian man with medical history of hypertension and peripheral arterial disease presented at the. Because typical electrocardiographic ecg symptoms refer to critical. Wellens syndrome litfl medical blog ecg library eponym. Aug 03, 2014 loosely based on wellens syndrome, a case report in annals of emergency medicine, march 1999 citation below. What this case adds to the literature is the fact that wellen. Electrocardiographic manifestations of wellens syndrome. A nearly stressful situationa case of wellens syndrome. The clinical presentation, pathophysiology, and management is discussed, and the importance of obtaining more than one electrocardiogram ecg is explained. American journal of emergency medicine, volume 20, issue 7, 638643. Atypical electrocardiographic manifestations of ischemia. After admission, 56 31% developed the changes within 24 hours, 10 5% within 2 days, 5 2. History of present illness a 45 yo white man with a history of htn, dm presents to the ed complaining of sharp, left sided chest pain for 2 weeks. Furthermore, the study reported that wellens syndrome ecg finding.
It has been shown to be strongly associated with critical, proximal lad artery stenosis. Mar 16, 2019 wellens syndrome is a pattern of deeply inverted or biphasic t waves in v23, which is highly specific for a critical stenosis of the left anterior descending artery lad. It can be easily overlooked as non specific st, t wave change. The wellens electrocardiographic ecg pattern, characterized by transient twave inversion in the anterior precordial leads and qt interval prolongation, was originally reported in the setting of acute coronary syndrome due to subocclusion of the proximal left anterior descending coronary artery. Captured during a period of no chest discomfort, revealed sinus rhythm with biphasic twaves in v 1v 3. Syndrome criteria include twave changes plus a history of anginal chest pain without serum. Most disturbing, the classic ekg findings of wellens syndrome can be obscure during the symptomatic phase of acute ischemia, and appear after chest pain has subsided when everyone breathes a sigh of relief and proceeds at a more relaxed pace. Stelevation myocardial infarction after pharmacologic. Wellens syndrome report of two cases europe pmc article. An atypical localization after an atypical transient left bundle branch block presentation wellens syndrome is a clinical presentation with a particular pattern of electrocardiographic ecg twave changes associated with critical, proximal left anterior descending lad coronary artery lesions. A 75yearold caucasian man with medical history of hypertension and peripheral arterial disease presented at the emergency department, transported by.
Positive p wave in leads i and ii, q wave 4 mm in lead iii, st depression 0. Originally thought of as two separate presentations, a and b, it is now considered an evolving wave form, initially of biphasic t wave inversions and later becoming symmetrical. Identifying the syndrome carries significant diagnostic any prognostic value. Electrocardiographic manifestations of wellens syndrome the. Wellens syndrome is also called his lad coronary artery twave syndrome in view of the characteristic twave changes. Challenges in clinical electrocardiography jama network. It is associated with critical proximal left anterior descending lad artery stenosis and impending massive anterior wall myocardial infarction. Cardiology acute coronary syndromes ischemic heart disease emergency medicine full text pdf link pdf. Wellens syndrome is a pattern of twave changes seen in the anterior leads on an ekg that is highly specific for critical stenosis of the left anterior descending lad coronary artery. It is crucial for emergency physicians and internists to be able to recognize these patterns, as they occur in. Hayden ge, brady wj, perron ad, somers mp, mattu a 2002 electrocardiographic twave inversion. A 31yearold male smoker with diabetes mellitus presented with intermittent, exertional chest pain. Van gorselen e, verheugt f, meursing b, oude ophuis a.
970 367 777 1186 1315 609 749 754 762 1423 896 138 363 594 12 1116 64 869 604 344 904 749 963 993 828 1411 237 3 1454