Exam

Wellen's Syndrome

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Wellen's Syndrome

  • 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
  • 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
  • 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)
  • Resources
  1. Wellen's Syndrome (Life in the FastLane)
    1. http://lifeinthefastlane.com/ecg-library/wellens-syndrome/
  • 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]