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Wellens' waves are NOT equivalent to Wellens' syndrome: Pseudo-Wellens' due to LVH and HTN Dr. Smith's ECG Blog: Wellens' waves are NOT equivalent to Wellens' syndrome: Pseudo-Wellens' due to LVH and HTN Saturday, January 10, 2015 A 20 year old male with end stage renal disease (ESRD) and hypertension presented with 1 hour of chest pain ("cramps"). He was hypertensive at 170/100. Here is his initial ECG: There is high voltage of LVH and biphasic T-waves, reminiscent of Wellens' waves (...) . The clinicians were concerned for Wellens' syndrome. He had been admitted 24 hours prior with fluid overload. Here was his ECG from that visit: There were no T-wave inversions at this time. Voltage is somewhat high, but not diagnostic of LVH. During that visit, his BP had been as high as 220/110. He had been dialyzed and discharged. Back to this visit Is this Wellens' syndrome? NO. Wellens' syndrome is a PAIN-FREE syndrome. It is also not associated with LVH or hypertension, which may result in Wellens
From the Bellevue Wards: Wellens? Syndrome Revisited From the Bellevue Wards: Wellens’ Syndrome Revisited – Clinical Correlations Search From the Bellevue Wards: Wellens’ Syndrome Revisited September 18, 2014 5 min read By Matthew Shou Lun Lee, MD Peer Reviewed Clinical Questions -How common are elevated cardiac enzymes during Wellens’ syndrome? -Can the EKG changes in Wellens’ syndrome be found with other causes? Background This post represents a follow-up to the . Wellens’ syndrome refers (...) or minimally-elevated (<1 mm) ST elevations -Normal precordial R wave progression -High grade LAD stenosis The clinical importance of Wellens’ syndrome was established early with a reported incidence of 14.2% in unstable angina cases . It has been known as a “pre-infarction” stage as the initial, pre-PCI study found that 75% of these patients went on to develop . Case Presentation A 52 year-old Polish woman presented to an outside hospital complaining of intermittent chest pain for 1 week. She had
Is there Wellens' syndrome in left bundle branch block? Or in inferior and lateral leads? Dr. Smith's ECG Blog: Is there Wellens' syndrome in left bundle branch block? Or in inferior and lateral leads? Sunday, February 11, 2018 Written by Pendell Meyers, with edits by Steve Smith A male in his 80s old had acute onset of chest pain. Here is his first ECG, time zero: What do you think? Sinus rhythm with left bundle branch block. There is concordant STE in leads II, V5, and V6. It may not reach (...) suggests that terminal T-wave inversion as a sign of reperfusion is sometimes still applicable in the setting of abnormal QRS such as LBBB and likely ventricular paced rhythm as well. We (Meyers and Smith) also published a case of Wellens' syndrome (involving the LAD) in LBBB: As a very brief review for new readers, terminal T-wave inversion is an expected finding with reperfusion of acute coronary occlusion which is well established in the presence of normal QRS conduction (no LBBB, paced rhythm, etc
Unusual Sign from an Unusual Cause: Wellens' Syndrome due to Myocardial Bridging It is vital to recognize correctly, chest pain of cardiac etiology. Most commonly, it is because of blood supply-demand inequity in the myocardium. However, the phenomenon of myocardial bridging as a cause of cardiac chest pain has come to attention reasonably recently. Herein, a coronary artery with a normal epicardial orientation develops a transient myocardial course. If the cardiac muscle burden is substantial
Electrocardiogram lead selection using critical thinking: concerning women and heart disease and a case of wellenssyndrome. When a patient enters the acute or critical care environment, it is imperative that the nurse select the best lead for monitoring the patient based on initial interpretation of the 12-lead electrocardiogram. Understanding that significant electrocardiogram changes can occur in the absence of chest pain presents a challenge, supporting the need for ongoing vigilant (...) monitoring throughout the critical care stay. The purposes of this article were to (1) discuss the leading cause of death in the United States, (2) highlight the significance related to the population of women, and (3) present the physiology of Wellenssyndrome along with monitoring recommendations to prevent unexpected outcomes for this patient population. A case study of Wellenssyndrome is included.
Wellenssyndrome in HIV-infected patients: Two case reports. Wellenssyndrome is a pattern of electrocardiographic (ECG) changes in the context of unstable angina characterized with deep inverted T-waves or biphasic T-waves in the precordial leads. These specific ECG changes are highly suggestive of stenosis in the left anterior descending artery (LAD), which can result in acute myocardial infarction, left ventricular dysfunction, or death. Human immunodeficiency virus (HIV) infection is known (...) smoker admitted for intermittent substernal chest pain of 1-day duration. ECG showed biphasic T-wave in V2 and deep T-waves inversion in V3-V4, coronary angiography showed 95% stenosis in the proximal LAD and a DES was placed.Wellens syndrome has characteristic ECG changes that indicates LAD stenosis. Early recognition of this syndrome, especially in HIV-infected patients who are high risk for cardiovascular disease, will help to avoid impending myocardial infarction.
BET 1: IN PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME, DOES WELLENS' SIGN ON THE ELECTROCARDIOGRAPH IDENTIFY CRITICAL LEFT ANTERIOR DESCENDING ARTERY STENOSIS? Wellens' syndrome consists of a history suggestive of an acute coronary syndrome and biphasic or deeply inverted T waves in ECG leads V2-V3. A shortcut review was carried out to establish whether this ECG pattern identifies patients with a critical left anterior descending artery stenosis. Six relevant papers were found. The clinical
Is it Wellens' Syndrome? Dr. Smith's ECG Blog: Is it Wellens' Syndrome? Friday, October 10, 2014 A middle-aged African American man with history of tobacco use, HTN, and chronic renal disease, but no known coronary disease, presented with chest pain. Symptoms in the 24 hours prior to presentation: On the evening prior to admission, he had an episode of sharp stabbing chest pain while talking to his wife, which improved after 30 minutes. This recurred on the morning of the date of presentation (...) was slightly concerned for the subtle beginnings of Wellens' waves in V2 and V3, so recorded this one 37 minutes later: 2. Now the QTc is 411 and there is definite terminal T-wave inversion in V3, and some also in V4 and V5. Importantly, there is none in V2. At this point, I was worried that this was "Wellen'ssyndrome" and initiated medical treatment for ACS. Wellens' is a syndrome and not an ECG finding . If you only look at the ECG, there will be many false positives. In order for the diagnosis
, Pattern A, with terminal T-wave inversion in V2-V4, preserved R-waves, and it appears to be Wellens' syndrome, as it occurred after resolution of typical angina pain. We assumed this was Wellens' syndrome and treated as such. Wellens' syndrome represents the aftermath of an unrecorded occlusion (STEMI) with spontaneous reperfusion. Wellens' waves are "reperfusion T-waves" and are identical to the T-waves seen after therapeutic reperfusion. If true Wellens', they always are associated with slightly (...) elevated troponin and always evolve over the next 12-72 hours into Pattern B waves (deep, symmetric). If they do not evolve in this manner, it is not true Wellens'. Wellenssyndrome requires that the pain be resolved and the R-waves are preserved. (In other words, the artery was occluded but has sponteneously reperfused, resulting in pain relief) It is important to monitor patients with Wellens' syndrome for re-occlusion, which is usually, but not always, associated with recurrent chest pain. Re
Wellen'sSyndromeWellensSyndrome Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Wellen'sSyndromeWellen'sSyndrome Aka: Wellen's (...) Suggests critical left anterior descending artery High risk for significant anterior wall in the coming days to weeks (regardless of symptoms) V. Resources Wellen'sSyndrome (Life in the FastLane) VI. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "WellensSyndrome." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Examination
Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome Dr. Smith's ECG Blog: Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome Friday, November 15, 2013 . This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. It was worse on the evening prior (...) to presentation while lying in bed, then recurred and resolved while at rest just prior to arriving in the ED. Here is the first ED ECG, with no pain: Sinus rhythm. Computerized QTc = 419. There is very subtle Wellens' waves in V2, less subtle in V3, still less in V4. This is nearly diagnostic of Wellens' syndrome: pain that resolves, biphasic T-waves with preservation of R-waves. It extends all the way out to V6, and there is some T flattening in I and aVL, so this is probably a proximal LAD lesion. The ECG
Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH) Dr. Smith's ECG Blog: Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH) Monday, June 18, 2012 A 52 year old male presented with epigastric pain, continuing in the emergency department. He has a history of hypertension, and is on amlodipine. Thinking that epigastric pain might be an anginal equivalent, this ECG was recorded: There is LVH. There are T-wave inversions in aVL and V3-V6. The physicians were worried (...) about Wellens' syndrome and treated for ACS. He was placed on a nitroglycerine drip. Initial troponin was negative. A followup ECG was done 3 hours later. Perhaps slightly less T-wave inversion. Nonspecific. He was admitted. All troponins were normal. A formal echo showed concentric LVH and there was also a subtle abnormality which the echocardiographer thought suspicious for LAD distribution ischemia. So he underwent a coronary angiogram which was completely normal. This is not Wellens'. Why? 1
." There is also T-wave inversion in aVL. This is very suggestive of Wellens' syndrome with a proximal LAD lesion. A subsequent ECG was recorded: There is now a bit less of the biphasic T-waves. The patient was admitted to observation. Her troponins [Ortho Clinical Diagnostics, Limit of detection is 0.012 mcg/L, 99% reference value ("positive" troponin) of 0.034 mcg/L] were less than 0.012, then 0.015, then less than 0.012. Since these are all below the 99% reference, and thus they are technically "negative (...) % stenosis of the proximal LAD, and another of the first diagonal off the LAD. Both were stented. This is an unusual case of "Wellens' syndrome." The amount of myocardial infarction (necrosis), as measured by troponin, was so small that the T-waves did not have the typical evolution (T-waves become deeper and more symmetric) seen here: Instead, the T-waves were dynamic, inverting, then normalizing. One might be tempted to call these normalizing T-waves "pseudonormalization." But this term is the name
. Down-Up waves in V2, V3 should make you think of reperfusing posterior MI or hypokalemia. 3. A very long QT (really a QU) should make you suspect hypokalemia. 4. Look for clear U-waves in other leads. 5. Finally, Wellens' syndrome is a SYNDROME that requires 1) typical anginal chest pain 2) Resolution of the chest pain 3) ECG recorded after resolution. Posted by Steve Smith at Labels: , , Reactions: 4 comments: So helpful Thank you Nice case that clearly shows what Wellen’s ST-T waves (...) Are These Wellens' Waves?? Dr. Smith's ECG Blog: Are These Wellens' Waves?? Monday, December 18, 2017 This is a repost. I've received a few questions like this, so wanted to re-inforce the idea of down-up vs. up-down T-waves Case : One of our residents texted me this ECG and was worried about Wellens' waves. A middle-aged male presented with vomiting. Here was the initial ED ECG: What do you think? Here is my response: " What is the Potassium?" Wellen's waves are always Up-Down T-waves
Wellens' syndrome, no culprit, what happened? Dr. Smith's ECG Blog: Wellens' syndrome, no culprit, what happened? Saturday, October 29, 2011 A 55 yo male with h/o smoking complained of 4 days of intermittent chest pain lasting up to a few hours each day. He presented to the ED pain free and had the following ECG at 1332: There is a suggestion of terminal T-wave inversion in V2, highly suggestive for early Wellens' syndrome. There is T-wave inversion in I and aVL diagnostic of ACS. The first (...) troponin returned with "minor increase" on a qualitative troponin I, so another quantitative troponin was sent and it was elevated at 0.325 ng/ml. The patient remained pain free. Another ECG was recorded at 1555: The T-wave inversion is more pronounced in V2, an evolution diagnostic of Wellens' syndrome. TWI in aVL again is clearly ischemic. . The patient was admitted to the hospital late on a Friday, and put on antithrombotics and antiplatelet agents. His troponin I peaked at 1.05 ng/ml that day
Successful Evaluation of Biphasic T-wave of WellensSyndrome in the Emergency Department WellensSyndrome (WS) is a condition characterized by typical changes in ECG, which are biphasic T-wave inversions (less common) or symmetric and deeply inverted T waves (including 75%) in lead V2-V3 chest derivations. WS is considered important because it has not only diagnostic value but also prognostic value.A 52-year-old male patient without cardiovascular disease or risk factors was admitted
Wellens' Syndrome with a proximal left anterior descending artery occlusion The case is a 52-year-old male admitted to cardiology department with chest tightness. Admission ECG showed nontypical T-wave changes in V2-V4 leads in pain peroids, and increasing severe narrowing of proximal LAD. Cardiac enzymes were abnormal. Emergency coronary angiography showed severe stenosis (99%) in proximal LAD.
Wellenssyndrome 26755666 2016 09 01 2018 11 13 1488-2329 188 7 2016 Apr 19 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ Wellenssyndrome. 529 10.1503/cmaj.150550 Das Debraj D Department of Medicine, Faculty of Medicine and Dentistry (Das), and Division of Cardiology, Mazankowski Alberta Heart Institute (Almajed), University of Alberta, Edmonton, Alta. email@example.com. Almajed Nawaf S NS Department of Medicine, Faculty of Medicine
Wellens' Syndrome â€“ Report of two cases Wellens' Syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending (LAD) artery stenosis. Diagnostic criteria of Wellens' Syndrome are history of chest pain, little or no cardiac enzyme elevation, little or no ST-segment elevation, no loss of precordial R waves, no pathologic precordial Q waves and typical T-wave changes. Urgent cardiac catheterization is vital to prevent myocardial necrosis (...) . Here we are presenting two cases with Wellens' Syndrome who had been sent for catheterization before marked myocardial infarction developed. The first case was 63 years old woman admitted to emergency room with a typical chest pain lasting for 7 h. Electrocardiography (ECG) revealed characteristic Type A Wellens' Syndrome. The second case was also a 64 years old female patient. She was admitted to emergency room with a chest pain lasting for 2 days. Type B Wellens' Syndrome was considered according