Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction

Abstract

Wellens’ syndrome, also known as LAD coronary T-wave syndrome or the ‘widow maker’, is a pre-infarction syndrome with non-classical ischemic ECG changes and unremarkable cardiac biomarkers. This syndrome continues to be a ‘can't miss’ for the clinician as delay in urgent angiography and intervention can result in anterior myocardial infarction, left ventricular dysfunction, arrhythmias, and death. We describe a case followed by a discussion of identification criteria and clinical implications.

Rapid assessment of health literacy on admission to the hospital

“…There is a case-based review of identification and treatment of foreign body aspiration ( 24 ). There is a radiology image case with Chilaiditi's sign ( 25 ) and an ECG abnormality characteristic of Wellens’ sign ( 26 ) and its clinical significance. There is a perspective piece on why bow ties for clinicians really make sense ( 27 ).…”

Understanding the ECG. Part 9: Myocardial ischaemia and infarction (part B)

“…Other ECG features associated with this syndrome include little or no ST elevation, normal precordial R-wave progression, and an absence of Q-waves (Khan et al, 2013) (figure 11). Because individuals with Wellen's syndrome present with unstable angina, cardiac biomarkers are typically normal, and pain intermittent (Hollar et al, 2015). The characteristic ECG pattern described above is recorded when patients are pain-free; during pain there may be transient ST elevation or hyperacute T-waves in the anterior chest leads, consistent with brief occlusion of the LAD (Hanna & Glancy, 2011).…”

“…In particular, deep symmetrical or biphasic Twave inversion in leads V2 and V3, with or without similar change in V1 and V4 to V6, is strongly associated with critical stenosis of the proximal LAD. In patient with unstable angina, this ECG pattern is referred to as Wellen's syndrome (Hollar et al, 2015). Other ECG features associated with this syndrome include little or no ST elevation, normal precordial R-wave progression, and an absence of Q-waves (Khan et al, 2013) (figure 11).…”

Omnious T-wave inversions: Wellens’ syndrome revisited

“…Acute myocardial infarction, left ventricular dysfunction, and death can ensue if appropriate and prompt interventional catheterization is not performed in a timely fashion (8). …”