Wellens syndrome

Wellens syndrome (also referred to as LAD coronary T-wave syndrome) refers to an ECG pattern specific for critical stenosis of the proximal left anterior descending (LAD artery  +/- resultant myocardial infarction in this territory. 

The anomalies described occur in patients with recent anginal chest pain, and do not have chest pain when the ECG is recorded. Cardiac biomarkers may demonstrate a slight elevation, but are commonly within normal limits. The most salient features may be found in the mid precordial leads (V2-3) although extension throughout the precordium (V1-6) has also been described.

ECG

• two distinct patterns of T wave abnormalities have been described as part of the Wellens syndrome, with clinical equivalence
  • deep, symmetric T wave inversion (more common)
    • sometimes referred to as a "pattern B" morphology
  • biphasic T waves with an initial positive deflection and a terminal negative component (Wellens pattern A)
    • this pattern may evolve with reocclusion (demonstrating a hyperacute morphology) or reperfusion, assuming the deep, symmetric inversion of the aforementioned pattern B
• the T waves characteristically arise from an ST segment which lacks significant elevation (<1 mm of ST elevation measured at the J point)
• cannot be diagnosed in the presence of poor R wave progression (R amplitude in V3 <3 mm) or Q waves

Clinical presentation

Patients can present to the emergency department pain-free and elevated cardiac enzymes are usually normal or only slightly elevated.

History and etymology

It was first described by Zwann and Wellens in 1982.