Wellens’ syndrome: a pattern to remember

Ramires, Tiago Gama; Sant'Anna, Joana Lezan; Pais, João; Picarra, B

doi:10.1136/bcr-2018-224582

Cited by 8 publications

(7 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Gerson and colleagues had previously described a similar phenomenon in 1979 when they initially reported exercise-induced U-waves and later U-waves inversions at rest as a marker of left anterior descending coronary artery ischemia [6,7]. But the pattern is now more commonly known as Wellens' syndrome, as also described by numerous authors in the subsequent years, likely because Wellens and the colleagues described it in detail and presented it correctly as T-wave abnormality instead of U-waves [8]. The diagnosis of Wellens syndrome is based mainly on ECG findings of deeply inverted or biphasic T-waves in Leads V2 and V3 (may also be seen in leads V1, V4, V5, and V6), without any significant ST segments elevation along with normal or slightly elevated cardiac enzymes.…”

Section: Discussionmentioning

confidence: 88%

Deeply Inverted and Biphasic T-Waves of Wellens’ Syndrome: A Characteristic Electrocardiographic Pattern Not To Forget

Ghumman¹,

Yarlagadda²,

Dogra³

et al. 2022

Cureus

View full text Add to dashboard Cite

Wellens' syndrome refers to specific electrocardiographic (ECG) abnormalities of deeply inverted T-waves in the precordial leads, mainly V1-V3, associated with critical stenosis of the proximal left anterior descending (LAD) coronary artery. Identifying this specific pattern on the electrocardiogram is important as emergent treatment can prevent life-threatening myocardial infarction. We present a case of Wellens' syndrome that had a combination of inverted and biphasic T-waves patterns and where timely identification of the abnormal ECG pattern by the emergency physician and prompt intervention by the cardiology team prevented the development of myocardial infarction and hence permanent damage to the heart.

show abstract

Section: Discussionmentioning

confidence: 88%

Deeply Inverted and Biphasic T-Waves of Wellens’ Syndrome: A Characteristic Electrocardiographic Pattern Not To Forget

Ghumman¹,

Yarlagadda²,

Dogra³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Wellens' syndrome is described as an abnormal EKG pattern consisting of deep T-wave inversions in the anterior chest leads associated with critical, proximal stenosis of the LAD.It consists of a clinical, laboratory, and EKG criterion, which involves a prior history of angina, minimal or no elevation of cardiac enzymes, minimal or no elevation of ST segment (<1mm), no pathological precordial Q waves, preservation of precordial R-wave progression and finally biphasic T-waves or deeply inverted T-waves present in leads V2 and V3.Lastly, it is important to note that the EKG is performed in a pain-free state as in symptomatic patients T-wave abnormalities appear to normalize or progress to ST-segment elevation [1,2]. In 1982 and 1989,de Zwaanand his colleaguesfirst described itin their two original studies.…”

Section: Discussionmentioning

confidence: 99%

How Well Do We Know Wellens?

Sam¹,

Jafri²,

Iddrisu³

et al. 2022

Cureus

View full text Add to dashboard Cite

Wellens' syndrome is a pattern of electrocardiographic T-wave changes that is associated with critical left anterior descending artery (LAD) stenosis. This syndrome continues to be under-recognized by clinicians and carries a significant risk of mortality if not intervened timely. We describe the case of an elderly Chinese woman who initially presented to the outpatient clinic with atypical chest pain. A routine EKG obtained in the office was documented as non-ischemic and was sent for a dobutamine stress echocardiogram. Pretest two-dimensional (2D) echocardiogram demonstrated akinesis and aneurysmal deformity of the entire apical myocardium and upon review of the previous EKG, Type 1 Wellens' sign was noted prompting emergent coronary angiogram, which revealed critical LAD stenosis (99%). She underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents.

show abstract

“…Wellens' syndrome classically indicate the presence of critical stenosis in LAD, particularly the proximal part of LAD (Ramires et al, 2018). A study conducted byBandara et al( 2018)of 30 patients with Wellens' syndrome found that majority 70% (22 patients) had proximal LAD critical stenosis, which was marked by ≥90% luminal stenosis.In our case, the critical stenosis was found to be in the mid rather than the proximal part of LAD.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Wellens’ Syndrome: An Ominous Sign of Left Anterior Descending Artery Critical Stenosis and Impending Anterior Myocardial Infarction

Willim¹,

Agustyana²,

Arilaksono

et al. 2020

INDONES J MED

View full text Add to dashboard Cite

Background: Wellens' syndrome is a potentially life-threatening condition, characterized by biphasic or deeply inverted T-waves changes in electrocardiographic (ECG) precordial leads, which associated with critical stenosis of left anterior descending (LAD) coronary artery and impending anterior myocardial infarction in patients presenting with unstable angina. This syndrome is an important sign for clinicians because delay in coronary angiography and revascularization may lead toanterior myocardial infarction, left ventricular dysfunction, and even death. Case presentation: A 50-year-old woman came to emergency department in a hospital in Bontang, with new onset intermittent typical chest pain lasting since 3 days. She had history of hypertension without regular medication. Physical examination was in normal ranges. An ECG obtained during chest pain-free period showed Wellens' type A with biphasic T waves in V2-V6 and preserved R-wave progression. Troponin T was slightly elevated. During observation, the ECG pattern changed from Wellens' type A to Wellens' type B with deep T-wave inversions in V2-V6 and preserved R-wave progression. Results:The patient was initially treated with conservative treatment. On the next day, she was referred to percutaneous coronary intervention-capable hospital in Samarinda. Coronary angiography revealed 90% stenosis of mid LAD. A drug-eluting stent was successfully implanted with restoration of LAD flow. She was discharged on the following day in good condition with medication of dual antiplatelet therapy, angiotensin-converting enzyme inhibitor, beta-blocker, and statin. Conclusion:Clinicians should be aware of the ECG changes in Wellens' syndrome, which may occur during pain-free period. Early recognition is crucial to avoid the development of anterior myocardial infarction. Immediate coronary angiography and revascularization is needed.

show abstract

Wellens’ syndrome: a pattern to remember

Cited by 8 publications

References 2 publications

Deeply Inverted and Biphasic T-Waves of Wellens’ Syndrome: A Characteristic Electrocardiographic Pattern Not To Forget

Deeply Inverted and Biphasic T-Waves of Wellens’ Syndrome: A Characteristic Electrocardiographic Pattern Not To Forget

How Well Do We Know Wellens?

A Case Report of Wellens’ Syndrome: An Ominous Sign of Left Anterior Descending Artery Critical Stenosis and Impending Anterior Myocardial Infarction

Contact Info

Product

Resources

About