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Wellens Syndrome

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21. Wellens' syndrome, no culprit, what happened?

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

2011 Dr Smith's ECG Blog

22. A Silent Alarm at Occupational Evaluation Two Months after a Normal Painful ECG: A Case of Wellens' syndrome (PubMed)

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

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2015 Case reports in cardiology

23. Pseudonormalization of Wellens' Waves

Pseudonormalization of Wellens' Waves Dr. Smith's ECG Blog: Pseudonormalization of Wellens' Waves Friday, March 14, 2014 A male in his 60's complained of intermittent chest pain all day. He was vague as to whether there was active chest pain, but it was definitely better at the time I talked to him. Here is his initial ECG: There is minimal ST elevation and there are subtle T-wave inversions in V2-V5 , highly suggestive of Wellen s' syndrome. Is the ST Elevation normal? Very low R-wave (...) amplitude suggests NOT. See formula here: The QTc was 380 ST Elevation at 60 ms after the J-point in lead V3 = 1.5 mm R-wave amplitude in V4 = 2.5 QRS V2 = 15.5 mm 3-variable formula = 23.4 (equals cutoff of 23.4, consistent with LAD occlusion) 4-variable formula = 18.34 (above 18.2, consistent with LAD occlusion) In Wellens' syndrome, the artery is open. T-wave inversion, as I've pointed out countless times (and hope I'm not belaboring) is indicative of reperfusion of the infarct-related vessel. So

2014 Dr Smith's ECG Blog

24. Wellens' waves appear and disappear again and again, all troponins negative: Unstable Angina

this as "biphasic T-waves in V3 and V4." 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: Not much changed 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. The ECG findings were not commented upon by the inpatient team, and the patient (...) very low 10% CV and can accurately measure changes below the 99% level. They may help diagnose unstable angina in the future. Case continued Later that day, the patient underwent an angiogram and had a 95% stenosis of the proximal LAD with thrombus, and another of the first diagonal off the LAD. Both were stented. Comment This is NOT Wellens' syndrome. In Wellens' syndrome , the T-waves are inverted when the patient is pain-free. The underlying pathology is that during the pain, the artery

2014 Dr Smith's ECG Blog

25. Subtle LAD Occlusion with Pseudonormalization of Wellens' Waves.

. Let's go back in time It turns out he had been in the hospital less than a month prior with a NonSTEMI with Wellens' syndrome. Here is his ED ECG from that visit, after resolution of chest pain: Classic Wellens'. Patient is at high risk of closure of his LAD. The physicians wanted to do an angiogram, but in spite of pleading with the patient, the patient would not agree to undergo any further testing because he felt fine. They discharged him on aspirin and clopidogrel. This was his pre-discharge ECG (...) is the post cath ECG: Marked loss of R-waves with persistent ST elevation. These may resolve over time but are highly correlated with development of LV aneurysm. Echo 5 days later showed anterolateral, septal, and apical wall motion abnormalities and an EF of 40%. Peak troponin I was 176 ng/mL (very high). Learning Points: 1. As I've endlessly repeated here, LAD occlusion may be very subtle. Any delay in diagnosis can result in significantly worse outcome. 2. Wellens' syndrome is the result of reperfusion

2014 Dr Smith's ECG Blog

26. ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens' Syndrome (PubMed)

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 (...) 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.

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2014 Case Reports in Emergency Medicine

27. First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

be sobering. I have seen cases of Wellens' syndrome that were ignored because of either negative troponins or normal echo or both and the patient did not get an angiogram and had a bad outcome. Wellen's syndrome is a Reperfusion syndrome. All of Wellens' cases in his studies (1, 2) had all of: 1) preserved R-waves 2) resolution of pain 3) restored flow to the anterior wall through either a) an open artery or b) collateral circulation. This is a rare case in which we can prove that the Wellens' waves (...) experience, all Wellens' with significant myocardial infarction have , so that the presence of type A or type B waves, I believe, are simply a matter of the timing of recording and the rapidity of evolution. In this case, the duration of ischemia was so brief that there was no such evolution, and there was near-normalization. When there is extremely brief ischemia, , , it may entirely reverse, especially in unstable angina (negative troponins). Lessons: 1. Wellens' syndrome represents a state

2013 Dr Smith's ECG Blog

28. Septal STEMI with lateral ST depression, then has collateral reperfusion resulting in Wellens' waves

that the STE is new ischemia and that this is STEMI. The STEMI was not recognized, the patient was put on a nitroglycerine drip (as well as aspirin, heparin, and clopidogrel), and pain continued. A subsequent ECG was recorded at 1 hour: 1 hour. The T-waves in V1-V3 are inverting and in V4-V6 are flattening. This is some evidence of reperfusion; is it Wellens'? The ECG has the appearance of Wellens' waves, but the patient is not pain free, so it is not Wellens' syndrome . Continued pain in the context (...) Septal STEMI with lateral ST depression, then has collateral reperfusion resulting in Wellens' waves Dr. Smith's ECG Blog: Septal STEMI with lateral ST depression, then has collateral reperfusion resulting in Wellens' waves Wednesday, March 20, 2013 A middle-aged male presented with 1.5 hours of 8/10 chest pain associated with diaphoresis and vomiting. He has a prior history of untreated hypertension and hyperlipidemia, and is a current smoker. He called 911. Prehospital vitals were normal

2013 Dr Smith's ECG Blog

29. What is Wellens’ Syndrome?

What is WellensSyndrome? What is WellensSyndrome? – Clinical Correlations Search What is WellensSyndrome? October 7, 2009 3 min read Figure 1: Biphasic T waves can be seen in leads V1, V2, with inverted T waves in V3-V6. (Image taken with permission from ) Reviewed by Robert Donnino MD, NYU Division of Cardiology References 1. de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis in left anterior descending coronary artery in patients (...) 1983, 52:14-8. Share: | | 2 comments on “ What is WellensSyndrome? ” on Symmetrical inverted T waves over the precordial leads (arrow head T waves) are said to be indicative of sub endocardial ischemia. Comments are closed. Sites We Follow: Useful Links: Questions? Comments? Contact us! © New York University. All rights reserved. Electronic ISSN 1944-0030. The content of this site is intended for health care professionals.

2009 Clinical Correlations

30. Harbinger of infarction: Wellens syndrome electrocardiographic abnormalities in the emergency department (PubMed)

Harbinger of infarction: Wellens syndrome electrocardiographic abnormalities in the emergency department 23585602 2014 01 08 2018 11 13 1715-5258 59 4 2013 Apr Canadian family physician Medecin de famille canadien Can Fam Physician Harbinger of infarction: Wellens syndrome electrocardiographic abnormalities in the emergency department. 365-6 Sowers Nicholas N Department of emergency medicine, Dalhousie University of Halifax, Halifax, NS. eng Case Reports Journal Article Canada Can Fam Physician (...) 0120300 0008-350X IM Aged Angina Pectoris etiology Coronary Artery Disease diagnosis Electrocardiography Emergency Service, Hospital Female Heart physiopathology Humans Myocardial Infarction diagnosis physiopathology Risk Factors Syndrome 2013 4 16 6 0 2013 4 16 6 0 2014 1 9 6 0 ppublish 23585602 59/4/365 PMC3625080 Am Heart J. 1982 Apr;103(4 Pt 2):730-6 6121481 Ann Emerg Med. 1999 Mar;33(3):347-51 10036351 Emerg Med J. 2009 Oct;26(10):750-1 19773507 Am J Emerg Med. 2002 Nov;20(7):638-43 12442245

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2013 Canadian Family Physician

31. Wellens syndrome: a life-saving diagnosis. (PubMed)

Wellens syndrome: a life-saving diagnosis. The diagnosis of acute coronary syndrome relies on clinical history, electrocardiographic (ECG) changes, and cardiac biomarkers; but within the spectrum of acute coronary syndrome, there exist subtle presentations that cannot afford to be overlooked. Wellens syndrome is one such example, in which a patient can present with both ECG changes that are not classic for myocardial ischemia and negative cardiac biomarkers. The characteristic ECG findings (...) associated with Wellens syndrome consist of deep, symmetric T-wave inversions in the anterior precordial leads. However, Wellens syndrome can also present as biphasic T-wave inversions in those same ECG leads. The associated critical stenosis of the proximal left anterior descending artery carries an immediately life-threatening prognosis if not recognized promptly (Am Heart J. 1982;103[4 Pt 2]:730-736). We describe a case of a less common manifestation of Wellens syndrome (type 1) followed

2012 American Journal of Emergency Medicine

32. Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1 (PubMed)

Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens' Syndrome and Upright T wave in V1 We present a case of Wellens' syndrome together with upright T wave in lead V(1) in a man presenting with atypical chest pain, and we discuss the significance of its prompt recognition by the emergency physicians who are involved in the evaluation of patients with coronary artery disease in emergency departments.

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2012 Western Journal of Emergency Medicine

33. 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

2015 FP Notebook

34. Aborted Myocardial Infarction in a Patient with Rapid Progression of Wellens Syndrome. (PubMed)

Aborted Myocardial Infarction in a Patient with Rapid Progression of Wellens Syndrome. Wellens syndrome refers to a distinct electrocardiographic pattern of deeply inverted or biphasic T waves in the anterior precordial leads, in the presence of critical proximal stenosis of the left anterior descending coronary artery (LAD). The natural history of the syndrome is an extensive myocardial infarction within weeks of hospital admission.This report describes a 63-year-old man in whom typical (...) electrocardiographic signs of Wellens syndrome advanced to persistent ST-segment elevation within 7min of presentation. Extensive anterior myocardial infarction (AMI) was aborted by primary percutaneous coronary intervention of a sub-occluded proximal LAD.Given the large area of the left ventricle supplied by a sub-occluded LAD, devastating AMI could have been expected and may have resulted in serious ventricular dysfunction and death. Therefore, early recognition of Wellens syndrome is essential and can

2011 Journal of Emergency Medicine

35. Wellens' syndrome and other electrocardiographic changes in a patient with a left anterior descending artery subocclusion associated with a left main coronary artery subocclusion. (PubMed)

Wellens' syndrome and other electrocardiographic changes in a patient with a left anterior descending artery subocclusion associated with a left main coronary artery subocclusion. Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Patients with unstable angina (...) have a higher incidence of left main coronary artery (LMCA) and proximal left anterior descending (LAD) coronary artery disease compared to patients with stable angina pectoris. In 1982, Wellens and colleagues described two electrocardiographic patterns that were predictive of critical narrowing of the proximal LAD artery, and were subsequently termed Wellens' syndrome. The criteria were: a) prior history of chest pain, b) little or no cardiac enzyme elevation, c) no pathologic precordial ST

2011 International journal of cardiology

36. CRACKCast E078 – Acute Coronary Syndromes Part A

significance? Image from: https://www.aliem.com/2013/06/wellens-syndrome-on-your-radar/ “A notable subgroup of ischemic T wave inversions is associated with Wellens syndrome, which classically manifests with either deep symmetrical T wave inversions (type I) or biphasic T wave changes (type II) in the anterior precordial leads. The presence of biphasic T waves is suggestive of ischemic heart disease. Other electrocardiographic features include isoelectric or minimally elevated (<1 mm) ST segments (...) CRACKCast E078 – Acute Coronary Syndromes Part A CRACKCast E078 - Acute Coronary Syndromes Part A - CanadiEM CRACKCast E078 – Acute Coronary Syndromes Part A In , by Adam Thomas May 15, 2017 This episode of CRACKCast covers Rosen’s Chapter 76, Acute Coronary Syndromes. Part A of this episode covers the essentials of Acute Coronary Syndromes, including DDx, pertinent ECG findings and the ever important STEMI equivalents. Shownotes – Rosen’s in Perspective Ischemic heart disease and CAD

2017 CandiEM

37. Atypical Presentation of Acute Coronary Syndrome and Importance of Wellens’ Syndrome (PubMed)

Atypical Presentation of Acute Coronary Syndrome and Importance of Wellens’ Syndrome BACKGROUND Acute coronary syndrome (ACS) is a common and potentially life-threatening condition encountered in emergency departments. Despite its dreaded nature, nearly one-third of ACS present without chest pain and may mislead clinicians. Additionally, Wellens' syndrome is a pre-infarction stage of significant proximal left anterior descending (LAD) artery stenosis, which can lead to extensive anterior wall (...) the importance of awareness of atypical presentation of ACS and importance of Wellens' syndrome. We also discuss the incidence of craniofacial symptoms of ACS, and the epidemiology, pathophysiology, management, and prognosis of Wellens' syndrome.

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2018 The American journal of case reports

38. Two case reports of Wellens’ syndrome (PubMed)

Two case reports of Wellens’ syndrome Wellens' syndrome is characterised by particular changes in electrocardiogram (ECG) precordial lead T-waves accompanied by proximal stenosis of the left anterior descending (LAD) artery. Two cases of electrocardiographic changes associated with Wellens' syndrome are presented here. Case 1, a 55-year-old female, was transferred to the First Affiliated Hospital of Xi'an Jiaotong University with intermittent and laborious angina pectoris. Her first ECG (...) in patients with characteristic ECGs, however, Wellens' syndrome has a wide spectrum of clinical manifestations and the ECG patterns may manifest itself persistently over a period of weeks. Therefore, ECG parameters should be combined with coronary angiography to confirm the presence of lesions.

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2018 The Journal of international medical research

39. Takotsubo Cardiomyopathy Presenting as Wellens’ Syndrome (PubMed)

Takotsubo Cardiomyopathy Presenting as Wellens’ Syndrome Takotsubo cardiomyopathy, also known as apical ballooning syndrome and stress cardiomyopathy, is a transient systolic and diastolic left ventricular dysfunction with a variety of cardiac wall-motion abnormalities that is increasingly being associated with significant morbidity and mortality. Wellens' syndrome is an electrocardiographic (ECG) pattern in a pain-free patient that is indicative of critical occlusion of the left anterior (...) descending coronary artery requiring immediate cardiac catheterization. The authors report a case of a patient presenting with ECG findings consistent with Wellens' syndrome that was later found to have Takotsubo cardiomyopathy with angiographically normal coronary arteries on cardiac catheterization after a seizure.

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2017 Clinical Practice and Cases in Emergency Medicine

40. Omnious T-wave inversions: Wellens’ syndrome revisited (PubMed)

Omnious T-wave inversions: Wellens’ syndrome revisited Wellens' syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even (...) death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens' syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI. Here, we report a case of an overweight man with 35 pack-year of smoking history who presented to Easton Hospital with intermittent pressing chest pain of 5/6 times within 10 day-period and was found to have type A Wellens' sign, which was biphasic T-waves in precordial leads V2

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2016 Journal of community hospital internal medicine perspectives

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