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Wellens Syndrome

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1. Is there Wellens' syndrome in left bundle branch block? Or in inferior and lateral leads?

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

2018 Dr Smith's ECG Blog

2. Unusual Sign from an Unusual Cause: Wellens' Syndrome due to Myocardial Bridging Full Text available with Trip Pro

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

2018 Case reports in cardiology

3. Pseudo-Wellens' syndrome and intermittent left bundle branch block in a case of acute cholecystitis. (Abstract)

Pseudo-Wellens' syndrome and intermittent left bundle branch block in a case of acute cholecystitis. We present a case of a 54-year-old male patient who was admitted to our Emergency Department (ED) with localized epigastric pain. Inflammation markers, ultrasound, and CT scan were inconsistent with an initial diagnosis of cholecystitis. However, there was additional evidence of cholecystolithiasis. The ECG showed new anterior biphasic T waves typical for a Wellens' type A ECG. Additionally (...) , the patient had an intermittent left bundle branch block (LBBB). The diagnostic challenges in differentiating possible diagnoses will be described, to which in this case, were either acute cholecystitis or acute coronary syndrome (ACS). A laparoscopic study confirmed acute cholecystitis. Coronary angiography showed no pathological processes associated with ACS. ECG abnormalities were initially ongoing, but were no longer detectable during an 8month follow up assessment.Copyright © 2018 Elsevier Inc. All

2018 American Journal of Emergency Medicine

4. From the Bellevue Wards: Wellens? Syndrome Revisited

From the Bellevue Wards: Wellens? Syndrome Revisited From the Bellevue Wards: WellensSyndrome Revisited – Clinical Correlations Search From the Bellevue Wards: WellensSyndrome Revisited September 18, 2014 5 min read By Matthew Shou Lun Lee, MD Peer Reviewed Clinical Questions -How common are elevated cardiac enzymes during Wellenssyndrome? -Can the EKG changes in Wellenssyndrome be found with other causes? Background This post represents a follow-up to the [1]. Wellenssyndrome refers (...) or minimally-elevated (<1 mm) ST elevations -Normal precordial R wave progression -High grade LAD stenosis The clinical importance of Wellenssyndrome was established early with a reported incidence of 14.2% in unstable angina cases [3]. 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 [2]. Case Presentation A 52 year-old Polish woman presented to an outside hospital complaining of intermittent chest pain for 1 week. She had

2014 Clinical Correlations

5. Wellens' waves are NOT equivalent to Wellens' syndrome: Pseudo-Wellens' due to LVH and HTN

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

2015 Dr Smith's ECG Blog

6. Wellens syndrome in HIV-infected patients: Two case reports. Full Text available with Trip Pro

Wellens syndrome in HIV-infected patients: Two case reports. Wellens syndrome 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.

2017 Medicine

7. BET 1: IN PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME, DOES WELLENS' SIGN ON THE ELECTROCARDIOGRAPH IDENTIFY CRITICAL LEFT ANTERIOR DESCENDING ARTERY STENOSIS? Full Text available with Trip Pro

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

2017 Emergency Medicine Journal

8. Dynamic, Reversible, Ischemic T-wave inversion mimics Wellens'. All trops negative.

of this patient’s underlying coronary disease could have been overlooked. I’d add the following points: I’ve always thought of WellensSyndrome as a way to predict high likelihood of a tight, proximal LAD lesion . True WellensSyndrome is seen BEFORE a large anterior infarction has occurred — thus, there should be preservation of anterior R waves. Therefore, the classic Wellens’ ECG Pattern A seen in ECG #1 , with steep terminal downsloping T waves and terminal T wave negativity in one or more anterior leads (...) , 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

2019 Dr Smith's ECG Blog

9. Wellen's Syndrome

Wellen's Syndrome Wellens Syndrome 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's Syndrome Wellen's Syndrome 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's Syndrome (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 "Wellens Syndrome." 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

2018 FP Notebook

10. Are these Wellens' waves?

Are these Wellens' waves? Dr. Smith's ECG Blog: Are these Wellens' waves? Friday, March 16, 2018 This ECG was sent to me by one of my residents, who was puzzled by it: This ECG is from a 21 yo M with PMH of poly-substance abuse. He presented with nausea and vomiting after drinking the night before. He denied any chest pain or shortness of breath. He has no other significant medical history he does not take any medications. This one was read by the computer as "Acute STEMI" (!!) What do you (...) think? My resident thought this looked like Wellens' pattern in lead V2 Some hours later, this was recorded: Now there is resolution of the inverted T-wave in V2 Electrolytes were normal. My response: I looked at the ECGs before reading anything. The one read as acute STEMI was clearly early repol to me. What particularly confuses one would be the T-wave inversion in V2. However , also notice that there is an rSr' in both V1 and V2. Notice that in the second ECG, these are gone and the T-wave

2018 Dr Smith's ECG Blog

11. Collateral Circulation to LAD and Wellens Sign

. Hypothesis The presence of coronary collateral circulation to the LAD masks the presence of a Wellens sign (both Type 1 and Type 2) in precordial leads V2-V4. Condition or disease Intervention/treatment Coronary Artery Disease Acute Myocardial Infarction Acute Myocardial Infarction of Anterior Wall Collateral Circulation, Any Site Other: Wellens Sign Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 1500 participants Observational Model: Cohort Time (...) provided by George Juang, Coney Island Hospital, Brooklyn, NY: wellens sign coronary collateral circulation acute myocardial infarction left anterior descending artery Additional relevant MeSH terms: Layout table for MeSH terms Infarction Coronary Artery Disease Myocardial Ischemia Coronary Disease Myocardial Infarction Anterior Wall Myocardial Infarction Ischemia Pathologic Processes Necrosis Heart Diseases Cardiovascular Diseases Arteriosclerosis Arterial Occlusive Diseases Vascular Diseases

2018 Clinical Trials

12. Are These Wellens' Waves??

. 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

2017 Dr Smith's ECG Blog

13. Successful Evaluation of Biphasic T-wave of Wellens Syndrome in the Emergency Department Full Text available with Trip Pro

Successful Evaluation of Biphasic T-wave of Wellens Syndrome in the Emergency Department Wellens Syndrome (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

2016 Acta Informatica Medica

14. Wellens' Syndrome – Report of two cases Full Text available with Trip Pro

Wellens' Syndrome – 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

2016 Turkish journal of emergency medicine

15. Wellens' Syndrome with a proximal left anterior descending artery occlusion Full Text available with Trip Pro

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.

2016 Clinical Case Reports

16. Wellens syndrome Full Text available with Trip Pro

Wellens syndrome 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 Wellens syndrome. 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. debraj.das@ualberta.ca. Almajed Nawaf S NS Department of Medicine, Faculty of Medicine

2016 CMAJ : Canadian Medical Association Journal

17. Posterior reperfusion T-waves: Wellens' syndrome of the posterior wall. (Abstract)

Posterior reperfusion T-waves: Wellens' syndrome of the posterior wall. Reperfusion after coronary occlusion (myocardial infarction, MI), as in Wellens' syndrome, is often represented on ECG as T-wave inversion in the leads overlying the affected myocardial wall(s). As an extension of this logic, reperfusion of the posterior wall should manifest on right precordial leads (which are opposite the posterior wall) as enlarged T-waves.We sought to determine whether T-wave amplitude (TWa) in leads V2

2016 Emergency Medicine Journal

18. A Silent Alarm at Occupational Evaluation Two Months after a Normal Painful ECG: A Case of Wellens' syndrome Full Text available with Trip Pro

A Silent Alarm at Occupational Evaluation Two Months after a Normal Painful ECG: A Case of Wellens' syndrome We describe a case of a 42-year-old man, with a previous episode of angina and a normal ECG and serum cardiac markers, and a two months later finding of biphasic T wave in leads V2-V3 and deeply inverted T wave in V4-V5 at a asymptomatic occupational evaluation. This is a typical ECG pattern of Wellens' syndrome. A subsequent coronary angiography showed a critical stenosis of proximal

2015 Case reports in cardiology

19. Is it Wellens' Syndrome?

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's syndrome" 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

2014 Dr Smith's ECG Blog

20. ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens' Syndrome Full Text available with Trip Pro

instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent with Wellens' syndrome that developed an acute anterior wall ST-elevation myocardial infarction after pharmacologic stress test. (...) ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens' Syndrome Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75% of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most

2014 Case Reports in Emergency Medicine

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