Prevalence and Clinical Implication of Wellens’ Sign in Patients With Non-ST-Segment Elevation Myocardial Infarction

Kobayashi, Akihiro; Misumida, Naoki; Aoi, Shunsuke; Kanei, Yumiko

doi:10.14740/cr856

Cited by 17 publications

(35 citation statements)

References 11 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Los ensayos iniciales incluyeron pacientes con AI y elevaciones mínimas de biomarcadores; no obstante, si la medición de troponina de alta sensibilidad hubiese estado disponible en aquellos estudios, la proporción de IMA podría haber llegado a 64% (6) . En cohortes con IMA ST no elevado, la incidencia y el rendimiento del PW son similares a los estudios iniciales (7) . Figura 1.…”

Section: Discussionunclassified

Atypical presentation of the Wellens electrocardiographic pattern associated with coronary bifurcation lesion

Alca-Clares

Hernández

Arce³

et al. 2021

Arch Peru Cardiol Cir Cardiovasc

View full text Add to dashboard Cite

Presentamos el caso de una paciente que ingresó a emergencia por angina inestable, con electrocardiograma inicial sin signos de isquemia aguda y evolución clínica favorable. Durante la hospitalización desarrolló el patrón electrocardiográfico de Wellens, señalado en la literatura como un hallazgo infrecuente, poco identificado y de pronóstico ominoso. Este patrón electrocardiográfico se detalla en derivadas precordiales, sugiriendo una lesión significativa de una arteria epicárdica principal; la paciente tuvo alteraciones electrocardiográficas similares en las derivadas laterales altas, en quien se confirmó el compromiso de bifurcación coronaria no descrita previamente en este escenario.

show abstract

Section: Discussionunclassified

Atypical presentation of the Wellens electrocardiographic pattern associated with coronary bifurcation lesion

Alca-Clares

Hernández

Arce³

et al. 2021

Arch Peru Cardiol Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…The incidence of the characteristic ECG pattern varies from 18% of patients with unstable angina in the original study (Wellens and de Zwaan, 1982), [ 2 ] 14% in the second study by the same authors (Wellens and de Zwaan, 1989) [ 4 ] to 8.8% of the patients with non-ST segment elevation myocardial infarction (Kobayashi, 2019). [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

Myocardial bridging—an unusual cause of Wellens syndrome

et al. 2020

View full text Add to dashboard Cite

Rationale: Coronary chest pain is usually ischemic in etiology and has various electrocardiographic presentations. Lately, it has been recognized that myocardial bridging (MB) with severe externally mechanical compression of an epicardial coronary artery during systole may result in myocardial ischemia. Such a phenomenon can be associated with chronic angina pectoris, acute coronary syndromes (ACS), coronary spasm, ventricular septal rupture, arrhythmias, exercise-induced atrioventricular conduction blocks, transient ventricular dysfunction, and sudden death. Patient concerns: We report the case of a 58-year-old woman presenting with recurrent episodes of constrictive chest pain during exercise within the last 2 weeks. Except for obesity, general and cardiovascular clinical examination on admission were normal. Diagnoses: The resting 12 lead electrocardiogram (ECG) revealed changes typically for Wellens syndrome. High-sensitive cardiac troponin I was normal. We established the diagnosis of low-risk non-ST-segment elevation acute coronary syndrome with a Global Registry of Acute Coronary Events risk score of 92 points. Interventions: The patient underwent coronary angiography, who showed subocclusive dynamic obstruction of the left anterior descending artery due to MB. Outcomes: The patient was managed conservatively. Her hospital course was uneventful and she was discharged on pharmacological therapy (clopidogrel, bisoprolol, amlodipine, atorvastatin, and metformin) with well-controlled symptoms on followup. Lessons: MB is an unusual cause of myocardial ischemia. Wellens syndrome is an unusual presentation of ACS. We present herein a rare case of Wellens syndrome caused by MB. This case highlights the importance of subtle and frequently overseen ECG findings when assessing patients with chest pain and second, the importance of considering nonatherosclerotic causes for ACS.

show abstract

“…Sensitivity and specificity of Wellens' sign to predict LAD critical stenosis were 24.6% and 96.2%, respectively. Notably, despite its high specificity of Wellens' sign for LAD lesion, it was also observed in patients with non-LAD culprit lesions and non-obstructive coronary artery disease [24].…”

Section: Wellens Syndromementioning

confidence: 95%

Particular electrocardiographic phenotypes in acute coronary syndromes

Avram¹,

Brezeanu²,

Iancu³

et al. 2020

Ro Med J.

View full text Add to dashboard Cite

Despite continuous efforts in early recognition and timely management, acute coronary syndromes (ACS) continue to be the most common cause of death worldwide. The electrocardiogram (ECG) is the fastest, repeatable and most accesible instrument with diagnostic value, prognostic significance and therapeutic implications. Based on the ECG, ACS are divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation ACS (NSTEACS). Current guidelines recommend emergency reperfusion theraphy only in patients with STEMI. Conventional criteria for the diagnosis of STEMI exclude the patients with atypical ECG findings, correlated with an increased risk of transmural myocardial infarction and considered STEMI equivalents. These particular ECG phenotypes are: new or presumably new bundle branch block, ST segment elevation in aVR, isolated posterior myocardial infarction, de Winter T waves, Wellens syndrome and ischaemia induced Brugada phenocopy. Rapid risk stratification in patients with NSTEACS is crucial for adequate management. The particular ECG phenotypes discussed herein proove the need to redefine the signs of the present or iminent coronary artery occlusion, especially the left anterior descending (LAD) artery, because many patient may benefit from early invasive treatment instead of conservative pharmacological treatment.

show abstract

Prevalence and Clinical Implication of Wellens’ Sign in Patients With Non-ST-Segment Elevation Myocardial Infarction

Cited by 17 publications

References 11 publications

Atypical presentation of the Wellens electrocardiographic pattern associated with coronary bifurcation lesion

Atypical presentation of the Wellens electrocardiographic pattern associated with coronary bifurcation lesion

Myocardial bridging—an unusual cause of Wellens syndrome

Particular electrocardiographic phenotypes in acute coronary syndromes

Contact Info

Product

Resources

About