Wellens' syndrome: Difference between revisions
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**Finding can be transient (persists for hours after pain has resolved and then disappears) | **Finding can be transient (persists for hours after pain has resolved and then disappears) | ||
**Preinfarction stage of CAD, and heralds extensive anterior wall MI | **Preinfarction stage of CAD, and heralds extensive anterior wall MI | ||
==Clinical Features== | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 17:37, 31 October 2015
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
Clinical Features
Differential Diagnosis
- High voltage
- PE
- RBBB
- Hypokalemia
- CNS Injury
- Persistent Juvenile T-wave pattern
- Digitalis Effect
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Diagnosis
- Biphasic T waves in leads V2-V3 OR symmetric, often deeply inverted T waves in V2-V3
- Prior history of chest pain (CP resolved)
- Little or no cardiac enzyme elevation
- No pathologic precordial Q waves
- Little or no ST-segment elevation
- No loss of precordial R waves
Two T-wave Characteristics:
- Type A: Inversion pattern - 75% - Deeply inverted and symmetric T-waves seen in EKG B
- Type B: Biphasic pattern - 25% - Biphasic T-waves (initial + deflection and terminal - deflection) seen in EKG A
Note Wellens criteria should not be diagnosed in a patetient with LVH.
Treatment
- Urgent cardiac catheterization
Stress testing contraindicated, may prove fatal
See Also
Video
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References
Wellens’ Syndrome. Annals of Emergency Medicine, March, 1999