Thanks to Dr. Kincade for today’s Morning Report!
Wellens Syndrome
- Pattern of inverted or biphasic T waves in precordial leads that are specific for critical LAD stenosis
- Critical stenosis LAD
- High risk of anterior MI w/o medical tx: 75% pt advance to ant MI in avg 8.5 days if only medically tx w/o PCI
***DO NOT SEND PT FOR STRESS TESTING
Criteria for Dx:
- Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6)
- Inverted T waves 76% biphasic T waves 24%
- Isoelectric or minimally-elevated ST segment (< 1mm)
- No precordial Q waves
- Preserved pericardial R wave progression (R wave > 3 small boxes tall DePace criteria)
- Recent history of angina
- ECG pattern present in pain-free state
- Normal or slightly elevated serum cardiac markers
References:
- De Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982;103(4 Pt 2):730-6.
- Rhinehardt J, Brady WJ, Perron AD et al. Electrocardiographic manifestations of Wellens’ syndrome. Am J Emerg Med 2002; 20: 638-43.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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To clarify further, these patients warrant a “Code H” activation. Cardiology “fellows” are sometimes unaware of this.