How to Trip Rapid Review

Step 1: Select articles relevant to your search (remember the system is only optimised for single intervention studies)

Step 2: press

Step 3: review the result, and maybe amend the or if you know better! If we're unsure of the overall sentiment of the trial we will display the conclusion under the article title. We then require you to tell us what the correct sentiment is.

253 results for

Wellens Syndrome

by
...
Latest & greatest
Alerts

Export results

Use check boxes to select individual results below

SmartSearch available

Trip's SmartSearch engine has discovered connected searches & results. Click to show

181. Chest Pain, SOB, anterior T-wave inversion, positive troponin

value of this finding for the diagnosis of PE were 88%, 99%, 97%, and 95%, respectively. In conclusion, the presence of negative T waves in both leads III and V 1 allows APE to be differentiated simply but accurately from ACS in patients with negative T waves in the precordial leads." Later, the patient had an echocardiogram which showed hyperdynamic LV fct (EF = 80%) and a dilated RV. PE was diagnosed by CT, with bilateral pulmonary emboli. If this were ACS, it would be Wellens' syndrome (...) , and this just does not look like Wellens' (difficult for me to explain why, but compare with other Wellens' cases on this blog). Anterior T-wave inversion, when accompanied by T-wave inversion in lead III, especially if tachycardic, should make you think of PE. A simple emergency physician performed bedside ultrasound would have confirmed this. Troponin will not help you in this diagnosis because, when there are T-wave inversions in either situation, the troponin is positive. Posted by Steve Smith at Labels

2011 Dr Smith's ECG Blog

182. Chest pain, resolved: don't forget to look at the previous and the prehospital ECG

below). There is also minimal ST elevation in V1 and V2 with the beginnings of T-wave inversion suggestive of anterior NSTEMI ("Wellens' syndrome"). The first ECG is substantially different from the previous ECG 3 years prior: Previous ECG from 3 years prior shows old inferior MI and baseline precordial ST elevation of early repolarization. There is upward concavity and normally upright T-waves. Prehospital ECG during chest pain, before nitro and aspirin. There is ST elevation and a large upright T (...) : Wellens' syndrome is chest pain that is relieved with terminal T-wave inversion on the initial, pain-free, ECG. There is preservation of R-waves, and there is evolution to deeper T-wave inversion (Wellens' Pattern B). It is due to brief LAD occlusion with reperfusion. This last evolution (Pattern B) did not occur in this case. See here for a series of . Posted by Steve Smith at Labels: , , , , Reactions: 2 comments: Anonymous Was he in cardiogenic shock? Heart rate of 100 is very atypical of pure

2011 Dr Smith's ECG Blog

183. Bizarre T-wave inversion of Stokes Adams attack (syncope and complete AV block), with alternating RBBB and LBBB

to ischemia, but I don't know if there is something else about this syndrome. I suspect it is a form of stress cardiomyopathy. The diffuse T inversions are similar to that. Steve Thank you for the wonderful case Dr. Smith! Broad symmetrical T waves are also known as neurogenic T's. Also with Wellen's the dr's I know are weary to diagnose it in a 3rd degree block. On the second 12 lead, and correct me if I'm wrong, it looks as though the first few beats are RBBB mimics and then turns into LBBB mimic (...) similiar last autumn, she was out for 20 seconds (captured on telemetry) and had general anterior T inversions. My first thought then was Wellens and I almost turned pale when I saw they sent her home with pacemaker but did no angio... So your case explains it all! Your case fits the Wellens criteria quite well though; * Symmetric, deep T wave inversion or biphasic T waves in V2-V5 or V6 during pain free periods * No precordial Q waves or loss of R waves * Minimal (<1mm), if any, ST elevations except

2011 Dr Smith's ECG Blog

184. Chest pain and LBBB. LBBB resolves and there is V1-V3 T-wave inversion.

in the ED and had this ECG: No difference. Sinus tach with appropriate ST segments. The following ECG was recorded later: Now the heart rate is 72 and LBBB is gone. There is, however, T-wave inversion in leads V1-V3, suggestive of Wellens' syndrome. Is this an anterior STEMI with LBBB? Did the occlusion reperfuse, resolving the LBBB and leaving the patient with reperfusion T-waves (Wellens' syndrome)? He was taken to the cath lab. All coronaries were completely normal. All troponins were undetectable (...) tach. Whenever you see tachycardia with bundle branch block, you should suspect that it is rate related BBB. Indeed, once the heart rate came down, the BBB resolved. After resolution, there was T-wave inversion in V1-V3, highly suggestive of ischemia. There are features of the T-wave inversion, however, which argue against ischemia. First, as I have pointed out in posts on pulmonary embolism (see links), T-wave inversion of anterior infarction (Wellens' syndrome) almost always has an upright T-wave

2011 Dr Smith's ECG Blog

185. Is it pulmonary embolism?

to PE or any cause of right heart strain. Here are . This is to illustrate that these T-wave inversions are due to acute right heart strain, which is caused by many etiologies other than PE, including but not limited to acute severe asthma and acute pneumonia. Hypoxia causes pulmonary vasoconstriction (pulmonary hypoxic vasocontriction) which puts strain on the right heart. Pulmonary embolism was ruled out. Posted by Steve Smith at Labels: , Reactions: 8 comments: Can't it be Wellen's syndrome (...) ? It could be Wellens', but it has a different look than Wellens' because of the humped look of the T-wave. All I can do is refer you to a couple Wellens' cases, and contrast with PE cases further down Wellens: http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html Wellens: http://hqmeded-ecg.blogspot.com/2011/03/classic-evolution-of-wellens-t-waves.html Another pulm embolism: http://hqmeded-ecg.blogspot.com/2011/03/chest-pain-sob-anterior-t-wave.html Another pulm embolism: http

2011 Dr Smith's ECG Blog

186. ST elevation in aVR, with widespread ST depression

in aVR, then you can safely give clopidogrel to this NSTEMI patient. If there is at least 1 mm STE in aVR, then a GP IIbIIIa inhibitor should be given instead. Posted by Steve Smith at Labels: , Reactions: 4 comments: In his publish book from 1992 "The ECG in Emergency Decision Making", Dr. "Hein" Wellens (Wellens Syndrome) and Mary Conover write in chapter 2 "ECG Identification of High-Risk Patients With Unstable Angina" on page 34: ECG recognition If there is St segment elevation in V1 and aVR plus (...) and/or three-vessel disease in patients with non-ST-segment elevation acute coronary syndrome. Am J Cardiol;107(4):495-500. They show that if there is not at least 1 mm STE in aVR, then ACS is highly unlikely to be due to severe 3-Vessel disease or Left Main. Why is this important? Because if such severe CAD is present, the patient is likely to need CABG. If they need CABG, then the surgeon will usually be unhappy if the patient received clopidogrel. So, here is a potential strategy : if there is no STE

2011 Dr Smith's ECG Blog

187. Rethinking the role of the brain in driving phantom pain

in the neuroscience community, but also for clinicians. Over the years it has been expanded in an attempt to explain other neuropathic pain conditions, such as complex regional pain syndrome. Beyond insights into the soft wiring of the brain, this theory provides clear predictions on how best to treat phantom pain: if pain is caused by maladaptive reorganisation, then to alleviate phantom pain we need to reverse it. One popular approach attempts to do this by “reinstating” the representation of the missing hand (...) the role of phantom limb pain is one of the most interesting parts of contemporary neurology. Thanks for your contributions to this discussion. Colin Palmer says Left foot amputationstill can feel my toes and have phantom pain on almost a daily occurrence.. sometime just as intense as the day it happened Frédéric Wellens, pht says Thanks Tamar for this insightful info on phantom limb. Indeed it is a complex clinical presentation and many explanations are often put forth to make sense of it. I use

2015 Body in Mind blog

188. Guidelines on Diagnosis and Management of Syncope

and pathophysiology . . . . . . . . . . . . . . 2635 1.2.1 Placing syncope in the larger framework of transient loss of consciousness (real or apparent) . . . . . . . . 2635 1.2.2 Classi?cation and pathophysiology of syncope . . . . 2636 1.2.2.1 Re?ex syncope (neurally mediated syncope) . . . 2637 1.2.2.2 Orthostatic hypotension and orthostatic intolerance syndromes . . . . . . . . . . . . . . . . . 2637 1.2.2.3 Cardiac syncope (cardiovascular) . . . . . . . . . . 2639 1.3 Epidemiology (...) intolerance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2656 3.1.1 Re?ex syncope . . . . . . . . . . . . . . . . . . . . . . . . 2657 3.1.1.1 Therapeutic options . . . . . . . . . . . . . . . . . . . 2657 3.1.1.2 Individual conditions . . . . . . . . . . . . . . . . . . . 2658 3.1.2 Orthostatic hypotension and orthostatic intolerance syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . 2658 3.2 Cardiac arrhythmias as primary cause . . . . . . . . . . . . 2659 3.2.1 Sinus node

2009 European Society of Cardiology

189. The pathogenesis of reversible T-wave inversions or large upright peaked T-waves: Sympathetic T-waves. (PubMed)

, Wellens or coronary and cardiac memory T waves. During the last 15 years, the reversible TWI and LUPTW in association with P-QTc have been described as characteristic ECG features in takotsubo syndrome (TS), which also may be triggered by the same aforementioned acute cardiac and non-cardiac disease entities. The pathogenesis of these reversible T-wave changes is not clear-cut. In this manuscript, substantial evidences for a causal link between the local cardiac sympathetic disruption

2015 International journal of cardiology

190. Advanced ECG by Amal Mattu in Singapore

the discordance elevation. EMS123lead.com has a nice ECG on concordance elevation in this . Sgarbossa's criteria also applies for patient with pacemakers. On the other hand, once there is LBBB (as in Sgarbossa's), the significance of STE in aVR cannot be ascertained anymore. 2. Wellen's Syndrome The problem is usually not with Wellen's Type 1 - it is rather easy to recognize Wellen's Type 1 with its typical deep symmetrical T inversion. On the other hand, Wellen's Type 2 can be easily missed if we do not know (...) what we are looking for. The danger with Wellen's is that at the time of presentation, the patient may seem deceptively stable with a subsiding episode of chest pain. However, in reality, these ECG changes in Wellen's may represent a critical ischemia of LAD; medical therapy most probably may not work. The patient should be sent urgently to the cath lab. Although relatively asymptomatic, the patient should be subjected to a stress test, as the critical ischemia may trigger sudden collapse

2014 Emergency Medicine Blog

191. Paroxysmal Supraventricular Tachycardia (Overview)

an underlying heart condition such as rheumatic heart disease, pericarditis, myocardial infarction, mitral valve prolapse, or preexcitation syndrome. [ , , ] An understanding of the electrophysiology of AV nodal tissue is very important in comprehending the mechanism of AVNRT. In most people, the AV node has a single conducting pathway that conducts impulses in an anterograde manner to depolarize the bundle of His. In certain cases, AV nodal tissue may have 2 conducting pathways with different (...) pathway in an anterograde manner, ventricular preexcitation results. This produces a short PR interval and a delta wave, as is observed in persons with Wolff-Parkinson-White (WPW) syndrome. A delta wave is the initial deflection of the QRS complex, owing to depolarization of the ventricles. (See the image below.) [ ] Wolff-Parkinson-White pattern. Note the short PR interval and slurred upstroke (delta wave) to the QRS complexes. Importantly, note that not all accessory pathways conduct

2014 eMedicine.com

192. Atrial Myxoma (Follow-up)

atrial myxoma masquerading vasculitis. J Assoc Physicians India . 2013 Dec. 61(12):912, 917-20. . Smith MJ, Chaudhry MA, Humphrey MB, Lozano PM. Atrial myxoma and bone changes: a paraneoplastic syndrome?. J Card Surg . 2011 Jul. 26(4):375-7. . Furukawa A, Kishi S, Aoki J. Large infected atrial myxoma with vegetations. Rev Esp Cardiol (Engl Ed) . 2013 Apr. 66(4):310. . Yuan SM. Cardiac myxoma in pregnancy: a comprehensive review. Rev Bras Cir Cardiovasc . 2015 Jul-Sep. 30(3):386-94. . Lanjewar DN (...) factors for postoperative recurrence of cardiac myxoma and the clinical managements: a report of 5 cases in one center and review of literature. Chin Med J (Engl) . 2012 Aug. 125(16):2914-8. . Shah IK, Dearani JA, Daly RC, et al. Cardiac myxomas: a 50-year experience with resection and analysis of risk factors for recurrence. Ann Thorac Surg . 2015 Aug. 100(2):495-500. . Deshpande RP, Casselman F, Bakir I, Cammu G, Wellens F, De Geest R. Endoscopic cardiac tumor resection. Ann Thorac Surg . 2007 Jun

2014 eMedicine.com

193. Unstable Angina (Diagnosis)

. . [Guideline] Acute coronary syndrome and myocardial infarction. EBM Guidelines. Evidence-Based Medicine [internet] . Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2011. . de Zwaan C, Bar FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J . Apr 1982. ;103(4 Pt 2):730-6. . Nisbet BC, Zlupko G. Repeat Wellens' syndrome: case report (...) Author: Walter Tan, MD, MS; Chief Editor: Eric H Yang, MD Share Email Print Feedback Close Sections Sections Unstable Angina Overview Practice Essentials Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which also includes ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). [ , ] Unstable angina is considered to be an ACS in which there is myocardial ischemia without detectable myocardial necrosis (ie

2014 eMedicine.com

194. Atrial Myxoma (Overview)

to inadequate resection or malignant change has been reported. Occasionally, atrial myxomas recur at a distant site because of intravascular tumor embolization. The risk of recurrence is higher in the familial myxoma syndrome. [ ] Symptoms from a cardiac myxoma are produced by mechanical interference with cardiac function or embolization and more pronounced when the myxomas are left-sided, racemosus, and over 5 cm in diameter. [ ] Because the tumors are intravascular and friable, myxomas account for most (...) vasculitis. J Assoc Physicians India . 2013 Dec. 61(12):912, 917-20. . Smith MJ, Chaudhry MA, Humphrey MB, Lozano PM. Atrial myxoma and bone changes: a paraneoplastic syndrome?. J Card Surg . 2011 Jul. 26(4):375-7. . Furukawa A, Kishi S, Aoki J. Large infected atrial myxoma with vegetations. Rev Esp Cardiol (Engl Ed) . 2013 Apr. 66(4):310. . Yuan SM. Cardiac myxoma in pregnancy: a comprehensive review. Rev Bras Cir Cardiovasc . 2015 Jul-Sep. 30(3):386-94. . Lanjewar DN, Bhatia VO, Lanjewar SD, Carney JA

2014 eMedicine.com

195. Right Ventricular Infarction (Diagnosis)

as a stimulus for secretion of atrial natriuretic factor. Increased levels of this polypeptide can be detrimental by virtue of the potent vasodilating, natriuretic, diuretic, and aldosterone-inhibiting properties of atrial natriuretic factor, thereby worsening the clinical syndrome of right ventricular infarction. [ ] The potential hemodynamic derangements associated with right ventricular infarction render the afflicted patient unusually sensitive to diminished preload (ie, volume) and loss (...) of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction. Am J Cardiol . 1999 Jan 15. 83(2):143-8. . Braat SH, Brugada P, den Dulk K, van Ommen V, Wellens HJ. Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. Am J Cardiol . 1984 Jun 1. 53(11):1538-41. . Braat SH, Brugada P, de Zwaan C, Coenegracht JM, Wellens HJ. Value of electrocardiogram in diagnosing right

2014 eMedicine.com

196. Ventricular Tachycardia (Diagnosis)

with hemodynamically unstable VT Most patients with prior MI and hemodynamically stable sustained VT Most cardiomyopathy patients with unexplained syncope (an arrhythmia is presumed) Most patients with genetic sudden death syndromes when unexplained syncope is noted Ablation Radiofrequency ablation (RFA) via endocardial or epicardial catheter placement can be used to treat VT in patients who have the conditions noted in the following bulleted list. For patients with structural heart disease, it is currently (...) and class III antiarrhythmics, phenothiazines, methadone, many others); drugs that slow myocardial conduction (eg, flecainide, propafenone, halothane) may also promote reentrant VT Inherited channelopathies (eg, long QT syndrome, short QT syndrome, , and catecholaminergic polymorphic ventricular tachycardia) Electrolyte imbalances (eg, , , ) Sympathomimetic agents, including intravenous (IV) inotropes and illicit drugs such as methamphetamine or cocaine , which can lead to biventricular tachycardia

2014 eMedicine.com

197. Atrial Myxoma (Diagnosis)

to inadequate resection or malignant change has been reported. Occasionally, atrial myxomas recur at a distant site because of intravascular tumor embolization. The risk of recurrence is higher in the familial myxoma syndrome. [ ] Symptoms from a cardiac myxoma are produced by mechanical interference with cardiac function or embolization and more pronounced when the myxomas are left-sided, racemosus, and over 5 cm in diameter. [ ] Because the tumors are intravascular and friable, myxomas account for most (...) vasculitis. J Assoc Physicians India . 2013 Dec. 61(12):912, 917-20. . Smith MJ, Chaudhry MA, Humphrey MB, Lozano PM. Atrial myxoma and bone changes: a paraneoplastic syndrome?. J Card Surg . 2011 Jul. 26(4):375-7. . Furukawa A, Kishi S, Aoki J. Large infected atrial myxoma with vegetations. Rev Esp Cardiol (Engl Ed) . 2013 Apr. 66(4):310. . Yuan SM. Cardiac myxoma in pregnancy: a comprehensive review. Rev Bras Cir Cardiovasc . 2015 Jul-Sep. 30(3):386-94. . Lanjewar DN, Bhatia VO, Lanjewar SD, Carney JA

2014 eMedicine.com

198. Sudden Cardiac Death (Treatment)

Apr 20. 332(16):1058-64. . Wellens HJ, Durrer D. Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol . 1974 Dec. 34(7):777-82. . Westenskow P, Splawski I, Timothy KW. Compound mutations: a common cause of severe long-QT syndrome. Circulation . 2004. 109(15):1834-41. Winslow RD, Mehta D, Fuster V. Sudden cardiac death: mechanisms, therapies and challenges. Nat Clin Pract (...) transplantation is indicated in cases of SCD and refractory heart failure in which significant improvement in actuarial survival is expected. Given a limited donor service, this form of treatment is expected to be beneficial for very few people who survive SCD. Patients with long QT syndrome who do not respond to beta-blockers are candidates for ICD implantation or high thoracic left sympathectomy. Previous Next: Consultations A cardiologist always should be participating in the care of these patients

2014 eMedicine.com

199. Programmed Electrical Stimulation (Treatment)

Apr 20. 332(16):1058-64. . Wellens HJ, Durrer D. Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol . 1974 Dec. 34(7):777-82. . Westenskow P, Splawski I, Timothy KW. Compound mutations: a common cause of severe long-QT syndrome. Circulation . 2004. 109(15):1834-41. Winslow RD, Mehta D, Fuster V. Sudden cardiac death: mechanisms, therapies and challenges. Nat Clin Pract (...) transplantation is indicated in cases of SCD and refractory heart failure in which significant improvement in actuarial survival is expected. Given a limited donor service, this form of treatment is expected to be beneficial for very few people who survive SCD. Patients with long QT syndrome who do not respond to beta-blockers are candidates for ICD implantation or high thoracic left sympathectomy. Previous Next: Consultations A cardiologist always should be participating in the care of these patients

2014 eMedicine.com

200. Right Ventricular Infarction (Overview)

as a stimulus for secretion of atrial natriuretic factor. Increased levels of this polypeptide can be detrimental by virtue of the potent vasodilating, natriuretic, diuretic, and aldosterone-inhibiting properties of atrial natriuretic factor, thereby worsening the clinical syndrome of right ventricular infarction. [ ] The potential hemodynamic derangements associated with right ventricular infarction render the afflicted patient unusually sensitive to diminished preload (ie, volume) and loss (...) of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction. Am J Cardiol . 1999 Jan 15. 83(2):143-8. . Braat SH, Brugada P, den Dulk K, van Ommen V, Wellens HJ. Value of lead V4R for recognition of the infarct coronary artery in acute inferior myocardial infarction. Am J Cardiol . 1984 Jun 1. 53(11):1538-41. . Braat SH, Brugada P, de Zwaan C, Coenegracht JM, Wellens HJ. Value of electrocardiogram in diagnosing right

2014 eMedicine.com

To help you find the content you need quickly, you can filter your results via the categories on the right-hand side >>>>