Wellens' syndrome

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Wellens' syndrome
Other names: Wellens syndrome, Wellens' sign, Wellens' warning, Wellens' waves, anterior descending T-wave syndrome
Wellens' Syndrome.png
ECG of Wellens' syndrome. Note biphasic T-waves in leads V1-V4.
SpecialtyCardiology
SymptomsAngina that resolves[1]
ComplicationsMyocardial infarction[1]
TypesType A, B[1]
CausesAtherosclerosis, coronary vasospasm, Takotsubo cardiomyopathy[1]
Diagnostic methodECG (deeply inverted or biphasic T waves in leads V2 and V3)[1]
Differential diagnosisBrain injury, left ventricular hypertrophy (LVH), right bundle branch block (RBBB), hypertrophic cardiomyopathy (HOCM), pulmonary embolism, Brugada syndrome[1][2]
TreatmentPercutaneous coronary intervention (PCI)[1]
MedicationAspirin, heparin[1]
FrequencyRelatively common[1]

Wellens' syndrome is an electrocardiogram (ECG) pattern which often represents critical narrowing of the left anterior descending (LAD) coronary artery.[1] People often have chest pain, which resolves by the time they arrive at the hospital.[1] Complications include a 75% risk of myocardial infarction (MI) within weeks without appropriate treatment.[1]

The underlying mechanism is believed to involve rupture of an atherosclerotic plaque leading to blockage of the LAD, followed by clot breakdown before a MI occurs.[1] In about 90% of cases there is near blockage of the proximal LAD.[3] It can also occur in coronary vasospasm and Takotsubo cardiomyopathy.[1]

Diagnosis is based on an ECG showing deeply inverted or biphasic T waves in at least leads V2 and V3.[1][3] Other findings may include ST-segment elevation of less than 1 mm, no Q waves, and normal or slightly increased troponin.[1][3] When chest pain occurs, the ECG may appear normal.[1]

Treatment is by percutaneous coronary intervention (PCI).[1] Until this can be carried out, aspirin and heparin is typically used.[1] Wellens' syndrome is relatively common.[1] It was first described in 1982 by Hein Wellens.[4][5]

Diagnosis

The diagnosis is by ECG showing:

Types

Type A involves deeply inverted T waves while type B involves biphasic T waves in V2 and V3.[1] Over time, type A changes may turn into type B changes.[2]

Differential diagnosis

Other conditions that may appear similarly include brain injury, left ventricular hypertrophy (LVH), right bundle branch block (RBBB), hypertrophic cardiomyopathy (HOCM), pulmonary embolism, and Brugada syndrome.[1][2] Additionally it may represent a normal ECG pattern in children.[2]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 Miner, B; Grigg, WS; Hart, EH (January 2022). "Wellens Syndrome". PMID 29494097. {{cite journal}}: Cite journal requires |journal= (help)
  2. 2.0 2.1 2.2 2.3 Cadogan, Mike; Buttner, Robert; Buttner, Mike Cadogan and Robert (1 August 2020). "Wellens Syndrome". Life in the Fast Lane • LITFL. Archived from the original on 1 August 2021. Retrieved 28 July 2022. Cite error: Invalid <ref> tag; name "LF2022" defined multiple times with different content
  3. 3.0 3.1 3.2 Tzimas, Georgios; Antiochos, Panagiotis; Monney, Pierre; Eeckhout, Eric; Meier, David; Fournier, Stephane; Harbaoui, Brahim; Muller, Olivier; Schläpfer, Jürg (October 2019). "Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention". The American Journal of Cardiology. 124 (8): 1305–1314. doi:10.1016/j.amjcard.2019.07.027.
  4. PA-C, David Roberts, MSPAS, RN (31 December 2019). Mastering the 12-Lead EKG. Springer Publishing Company. p. 407. ISBN 978-0-8261-8194-7. Archived from the original on 28 July 2022. Retrieved 28 July 2022.
  5. de Zwaan, C; Bär FW; Wellens HJJ (April 1982). "Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction". American Heart Journal. 103 (4): 730–736. doi:10.1016/0002-8703(82)90480-X. PMID 6121481.

External links