Wellen′s syndrome: An ominous EKG pattern

Abstract

Wellen's syndrome is a characteristic T-wave on an electrocardiogram during a pain-free period in a patient with intermittent chest pain. This finding suggests a high-degree stenosis of the proximal left anterior descending (LAD) coronary artery that will soon result in an acute anterior wall myocardial infarction (MI) if the patient is not urgently catheterized and the occlusion opened. This case report discusses a young male patient with no known cardiac disease with an EKG that demonstrates the classic Wellen's T-waves. He was urgently taken to cardiac catheterization and his 95% proximal LAD stenosis was reduced via drug-eluding stent. Through knowledge of Wellen's T-waves, more anterior wall MIs can be prevented.

Wellens’ Syndrome and Impending Anterior Wall Myocardial Infarction: A Case Report

“…Their study from patients with unstable angina showed that 18% of subject had the wellenoid ECG pattern and the results was 75% of the subject who did not performed revascularization developed anterior wall myocardial infarction within a few weeks [2]. The second study in 1989, from all patients with Wellens' syndrome, ECG patterns were found significant stenosis in proximal LAD artery [3].…”

“…Treadmill Stress Test should be avoided because it potentially induced myocardial infarct and also results in severe left ventricular dysfunction. Prediction of severity of coronary artery from ECG is very important for decreasing morbidity and mortality of Wellens' syndrome [3]. Early management of Wellens' syndrome is generally same as acute coronary syndrome (Table 2).…”

“…It is useful for evaluating further management, angioplasty or coronary artery bypass procedure [4]. Chest X-ray Table 2: Early management of Wellens' syndrome [3].…”

An incidental case of Wellens' syndrome in a community emergency department

“…[8] Our patient underwent an exercise stress test, such a procedure should not be performed in patients with Wellens' syndrome as increased cardiac demand along with a critically stenosed LAD branch can trigger a MI. [5,9] Thus, we recommend the routine invasive strategy for patients with Wellens' syndrome. It is very important for health care providers to identify patients with ECG findings that are characteristic of Wellens' Furthermore, as in our case, ECG changes can normalize completely in 90% of cases after appropriate intervention.…”

A Case of Nonischemic T-Wave Inversions

“…Importantly, these patterns include isoelectric or minimally elevated ST segments, absence of precordial Q waves, a history of anginal chest pain with the ECG being obtained during a chest pain-free interval, and normal cardiac enzyme levels. [3][4][5] While this ECG raises concern for a type 1 Wellens pattern, a closer inspection of the ECG reveals (1) tall R waves in the right precordial leads in concert with deep S waves in the lateral precordial leads; (2) an R wave to S wave amplitude ratio greater than 1 in lead V1; (3) right atrial enlargement suggested by the P wave taller than 2.5 mm in leads II and III and aVF (historically known p pulmonale, …”