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Wellen's Syndrome

Aka: Wellen's Syndrome
  1. Criteria
    1. Anterior T Waves abnormality in leads V2 and V3 (may involve all precordial leads)
      1. Type A: Biphasic T Waves, initially positive and then negative (25% of cases)
      2. Type B: Deep T Wave inversion (50% of cases)
    2. ST segment may be normal or <1 mm of ST Elevation
    3. No precordial Q waves and preserved precordial R Waves
    4. Associated with recent Angina, but EKG performed when pain free
    5. Cardiac enzymes normal or minimally elevated
  2. Differential Diagnosis
    1. See T Wave
    2. Pulmonary Embolism
    3. Right Bundle Branch Block
    4. Left Bundle Branch Block
    5. Hypertrophic Cardiomyopathy
    6. Normal variant (e.g. children)
    7. Brugada Syndrome
    8. Hypokalemia
  3. Interpretation
    1. Suggests critical left anterior descending artery
    2. High risk for significant anterior wall Myocardial Infarction in the coming days to weeks (regardless of symptoms)
  4. Resources
    1. Wellen's Syndrome (Life in the FastLane)
      1. http://lifeinthefastlane.com/ecg-library/wellens-syndrome/
  5. References
    1. Rhinehart (2002) Am J Emerg Med 20(7):638-43 +PMID:12442245 [PubMed]
    2. Tatli (2009) Cardiol J 16(1):73-5 +PMID:19130419 [PubMed]

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