Wellens’ syndrome is a significant ECG finding in certain patients having chest pain because it indicates critical LAD stenosis and means early intervention.
Let’s find out its details in this post!
Introduction
Wellens’ Syndrome is a clinical syndrome, characterized by biphasic or deeply inverted T-waves in leads V2 and V3. There is also a history of recent chest pain which has now resolved.
These features are highly specific for critical stenosis of the left anterior descending (LAD) artery.
Clinical significance
Identifying the syndrome is very important because:
1. It carries significant diagnostic and prognostic value as these patients have a high risk of developing an acute MI in the following days to a week. The risk of sudden cardiac arrest is also significantly high.
2. Due to critical LAD stenosis, these patients do poorly with medical management. Therefore invasive therapy is needed in them.
3. These patients shall not be subjected to stress tests due to high risk of developing MI or cardiac arrest. Instead, the investigation of choice in them is coronary angiography.
Diagnostic Criteria
1. Symmetrical deep inverted T waves or biphasic T waves, and
2. The observation of described ECG findings during the painless period
3. ST segment is isoelectric or is mildly elevated (1 mm)
4. Absence of precordial Q waves
5. History of angina
6. Normal or mildly elevated cardiac enzymes
Types of Wellens syndrome
Wellens’ syndrome is divided into type A and type B.
– Type A is found in 25% of cases while type B is in 75%.
– In type A, there are biphasic T waves typically observed in V2-V3. While In type B, there are deep, negative T waves in leads V2 and V3.
In patients having Wellen’s syndrome, upright T waves are expected during pain. This is called the “pseudonormalisation” of T waves.
The character of the chest pain might be in the form of typical, or atypical angina.
Treatment
Early percutaneous coronary intervention (PCI) saves lives.
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