Wellens' syndrome

Background

• T wave abnormality that is associated with critical LAD stenosis
  • Finding can be transient (persists for hours after pain has resolved and then disappears)
  • Preinfarction stage of CAD, and heralds extensive anterior wall MI

Criteria

1. Biphasic T waves in leads V2-V3 OR symmetric, often deeply inverted T waves in V2-V3
2. Prior history of chest pain
3. Little or no cardiac enzyme elevation
4. No pathologic precordial Q waves
5. Little or no ST-segment elevation
6. No loss of precordial R waves

• A: Biphasic pattern
• B: Inversion pattern

Note Wellens criteria should not be diagnosed in a patetient with LVH. 

Treatment

1. Urgent cardiac catheterization

Source

Wellens’ Syndrome. Annals of Emergency Medicine, March, 1999