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.

320 results for

Wellens Syndrome

Latest & greatest

Export results

Use check boxes to select individual results below

SmartSearch available

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

101. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion)

number of hereditary conditions can be associated with cardiac arrhythmias, and the Level III trainee must be familiar with inherited ion channel disorders such as long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic VT as well as with inherited cardiomyopathies that have arrhythmic manifestations including hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia/cardiomyopathy, myotonic dystrophy, other muscular dystrophies, and other types (...) of cardiomyopathies. In addition, numerous autoimmune and inflammatory disorders have potential electrophysiological manifestations. The Level III trainee shall develop clinically applicable knowledge of the basic and clinical sciences that underlie these disorders and apply this knowledge in patient care. The Level III trainee is not expected to be expert in the complete management of patients with these conditions and syndromes but must be able to use information technology or other available methodologies

2015 American Heart Association

102. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Full Text available with Trip Pro

conditions can be complex, especially when recommendations applicable to coexisting illnesses are discordant or interacting. The guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances. The recommendations should not replace clinical judgment. Clinical Implementation Management in accordance with guideline recommendations is effective only when followed. Adherence to recommendations can be enhanced by shared decision making between clinicians (...) disease PACES/HRS 2015 (in press) Postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope HRS 2015 Arrhythmias in adult congenital heart disease PACES/HRS 2014 Catheter and surgical ablation of atrial fibrillation HRS/EHRA/ECAS 2012 CPR and emergency cardiovascular care AHA 2010 * A revision to the current document is being prepared, with publication expected in late 2015. AATS indicates American Association for Thoracic Surgery; ACC, American College of Cardiology; ACCP

2015 American Heart Association

103. What will you do for this patient transferred to you who is now asymptomatic?

of a practitioner with advanced ECG interpretation training. The same reasoning applies to patients with unequivocal ECG evidence of reperfusion from Occlusion MI (Wellens syndrome, e.g. reperfusion of anterior Occlusion MI without recorded ECG during occlusion). Both groups of patients are at very high risk of reocclusion, and reocclusion may be clinically silent or too late to prevent myocardial loss or death. =================================================================== Timing of Reperfusion Therapy (...) maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. The same reasoning applies to patients with unequivocal ECG evidence of reperfusion from Occlusion MI (Wellens syndrome, e.g. reperfusion of anterior Occlusion MI without recorded ECG during occlusion). Both groups of patients are at very high risk of reocclusion, and reocclusion may be clinically silent or too late to prevent

2019 Dr Smith's ECG Blog

104. Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention. (Abstract)

risk, ECG patterns of acute coronary syndrome, often associated with coronary occlusion or critical stenosis. After screening 997 studies, we identified the following distinct "STEMI equivalent" ECG patterns: Wellens' syndrome, de Winter sign, hyperacute T waves, left bundle branch block-including paced rhythm-and right bundle branch block. For each pattern, a brief summary of the existing evidence, together with the sensitivity, specificity, and positive predictive value-whenever available (...) -are presented. In conclusion, prompt recognition of "STEMI equivalent" ECG patterns is crucial for every physician or paramedic dealing with acute coronary syndrome patients in the emergency department or the prehospital setting, as misinterpretation of those high risk presentations can lead to reperfusion delays and worse outcomes.Copyright © 2019 Elsevier Inc. All rights reserved.

2019 American Journal of Cardiology

105. Safety and quality issues associated with the care of patients with cognitive impairment in acute care settings

patient journey for a person with dementia and/or delirium? The purpose of this review is to identify best practice in caring for patients with cognitive impairment (CI) in acute hospital settings. CI refers to patients with dementia and delirium but can include other conditions. For the purposes of this report, ‘Hospitals’ is defined as acute care settings and includes care provided by acute care institutions in other settings (e.g. Multipurpose Services and Hospital in the Home). It does not include (...) are consistently worse than the outcomes of patients who recover from delirium. 34 The risk of developing delirium increases with increasing age. Patients aged = 65 years are three times more likely to develop delirium than younger patients (OR = 3.03), while patients aged = 80 years are five times more likely to develop delirium than younger patients (OR = 5.22). 2 11Issues Magnitude of the problem Cognitive Decline/ Dementia Studies suggest that critical illness and ICU treatment are associated with long

2013 Sax Institute Evidence Check

106. Inpatient rehabilitation services for the frail elderly

, Robben SH, Olde Rikkert MG. Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review. BMJ Quality and Safety 2011; 20: 680-91. 5. Baztan J J, Suarez-Garcia F M, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez- Artalejo F. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta- analysis. BMJ 2009; 338(b50). 6. Cameron I, Crotty M, Currie C (...) rehabilitation for older people with hip fractures. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007125. DOI: 10.1002/14651858.CD007125.pub2. 11. Stuck AE, Siu AL, Wieland D, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032-6. 12. Van Craen K, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, et al. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis

2013 Evidence briefings

107. Tachycardia and ST Elevation.

can be distinguished by the size of the T-wave, specifically the T/QRS ratio: --LV aneurysm has a relatively small T-wave, often with some slight (shallow) inversion. --Acute MI has a large upright T-wave, but may be inverted if reperfused (shallow in the case of Wellens' pattern A; deep in patthern B, which is a later evolution). However, Wellens' waves are preceded by R-waves, not by QS-waves. LV aneurysm rule: One should especially suspect LV aneurysm, and use the rule, when there are QS-waves (...) controlled conditions after the rate has slowed. P EARL # 4 : No matter how you might try to imagine “interference” from flutter waves affecting ST-T wave appearance in the anterior leads of ECG #1 — there is ≥2mm of ST segment elevation in lead aVL ( LIGHT GREEN arrows, seen within the GREEN rectangle ) that can not be explained away by flutter waves distorting the ST segment. That’s because we see NOTHING resembling flutter waves occurring at half-the-R-R interval distance away from the ST elevation

2018 Dr Smith's ECG Blog

108. An athletic 30-something woman with acute substernal chest pressure Full Text available with Trip Pro

— but that all chest pain had resolved at the time of presentation — and, that instead of ECG #1 being her initial tracing, that ECG #4 was her initial tracing . If this were the case, the appearance of the ST-T waves in the mid-chest leads of ECG #4 would be consistent with Wellens’ “Syndrome” — and would serve as an indicator of a tight, proximal LAD lesion in need of revascularization. Posted by Steve Smith at Reactions: No comments: Post a Comment Subscribe to: Recommended Resources , . Dr. Stephen W (...) to the angiographer as if it was a spontaneous coronary artery dissection . It seems that there was some uncertainly about this. The lesion was stented. ECG at time 19 hours after cath: Wellens' Pattern A T-waves are present (terminal T-wave inversion) Pattern A is in contrast to Pattern B, which is a further evolutionary stage of Wellens and is more deep and symmetric. These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. Regional

2018 Dr Smith's ECG Blog

109. Chest pain and T-wave inversion in lead V2

over age 14 but younger than 30. It is common in young women (these are the typical juvenile T-waves, link to relevant post above). T-wave inversion in V2 occurs in many pathologies, including posterior MI, pulmonary embolism, Wellens' syndrome. It is one of the minor criteria for arrhythmogenic right ventricular dysplas ia (" Minor: Inverted T-waves in right precordial leads V1-V2") Here is my list of Normal and Pathologic T-wave inversion: • Normal t wave vector is leftward, inferior and anterior (...) immediately saw that the computer was incorrect, but I found 2 abnormalities. What are they? I showed this to several physicians. They were worried about the T-wave inversion in V2. One mentioned "Wellens' waves" Another asked: "Are these juvenile T-waves?" (very good question!) For more on this: What do you think? I keep getting response tweets that T-wave inversion in V2 is normal. It is not normal. It is not necessarily pathologic, but it is not normal. It occurs normally in approximately 1% of males

2018 Dr Smith's ECG Blog

110. Chest pressure during exertion, evolution of inverted T-waves and Troponins. Surprise Angiogram.

), that had resolved. Very worrisome T-wave inversion in V2, V3. Looks like Wellens' syndrome and is changed from the ECG 9 days prior (below). The patient was to be admitted for this, but left the ED without warning. Baseline 10 days prior to ECG 6 (ECG 7) I was sure that all these ECGs pointed to a reperfused high lateral MI, probably a first diagonal (since V2 was involved.) Angiogram : Normal coronary arteries! Interpretation : It is uncertain what the etiology was. Spasm? Thrombosis with complete

2018 Dr Smith's ECG Blog

111. Besides the Nonspecific T-wave Inversion in aVL, What Else is Abnormal on this ECG?

an episode of unresponsiveness. Previous ECG: First ECG with arrows (again) Slight STD in inferior and lateral leads, some STE in aVL, and profound negative U-waves in V3-V5. After Reperfusion of LAD: Reperfusion T-waves (Wellens' waves) Short Summary of the U-wave [Adapted from one of my chapters (in the ACS section, which I edited) in Critical Decisions in Emergency and Acute Care Electrocardiography. There are some contributions by Farkas Laszlo.] Note: The research on this topic is not of the most (...) less than 2 mm in height AND less than 25% of the T-wave in height. U wave duration is about 170+-30 ms. It is usually positive in II, isoelectric in aVL and aVR and may be, less commonly, inverted in III and aVF. It should be upright in precordial leads. When inverted in the precordial leads, it implies structural or ischemic heart disease. It is normally less than 2 mm in height AND less than 25% of the T-wave in height. What are the implications of negative U-waves? A negative U-wave, other than

2018 Dr Smith's ECG Blog

112. T-wave inversions and dynamic ST elevation

, "Wellens' syndrome" requires clinical factors in addition to ECG findings, including chest pain which resolved prior to recording of the ECG. Wellens' syndrome is not diagnosed during ongoing pain, as this would not be consistent with reperfusion (which should produce resolution of pain). On the ECG Wellens' syndrome also requires that there are preserved R-waves in the precordial leads. Below I have reproduced a list of findings of BTWI from a series of other blog posts on this topic on this site (...) , and we will go through each one with respect to the first presentation ECG: 1. There is a relatively short QT interval (QTc less than 425) YES . Computerized QTc in this case was 424 msec. 2. The leads with T-wave inversion often have very distinct J-waves YES . J-waves are present in V4-6, as well as II, III, aVF. 3. The T-wave inversion is usually in leads V3-V6 (in contrast to Wellens' syndrome, in which they are V2-V4) Here the TWI is in leads V3-4 only. So this doesn't really distinguish. Also

2018 Dr Smith's ECG Blog

113. Do you want to be interrupted to view what the computer calls normal or nonspecific ECGs? 2 cases at once!

on and off for 3 days. He stated that it had never completely resolved but was constant, with waxing and waning, for the entire 72 hours. At the moment I was talking with him it seemed to be on the waning end of the spectrum. This "waning" corresponded with the inverted T-wave in lead III (inverted T-waves are signs of reperfusion -- this is Wellens' of the inferior wall). The artery was probably open and so his MI was less acute than the woman's. This is called" " of the ECG of MI. Female patient: I (...) went to tend to the this woman, whose T-waves were upright and hyperacute, and made sure everything was set for the cath lab. Male patient: Then I returned to the man and he was up out of bed, standing next to the bed and leaning on it, looking ill, holding his chest and stating that he had "terrible gas". This alarmed me, so I brought him to the stabilization room as well, and recorded this ECG: Now the inferior T-waves are upright (pseudonormalization) and there is more ST elevation and more

2018 Dr Smith's ECG Blog

114. A crashing patient with an abnormal ECG that you must recognize

inversions can be very similar in anterior reperfusion syndrome (Wellens). It is also true that anterior and inferior T-wave inversion could be consistent with reperfusion of a type III wraparound LAD occlusion, despite the fact that . However, in reperfusion (Wellens'), the symptoms are resolved at the time of the ECG. Thus, it is critical to compare the ECG with the symptomatic state of the patient! Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1. Wellens' is a syndrome of a painless (...) from PE. Primer on the ECG in Pulmonary Embolism: These are findings of acute right heart strain, and could be seen in any condition which results in a rapid rise in pulmonary artery pressure. This includes hypoxia because of "pulmonary hypoxic vasoconstriction" The ECG is not sensitive for PE, but when there are findings such as S1Q3T3 or anterior T-wave inversions, or new RBBB, then they have a (+) likelihood ratio and the S1Q3T3, or even just the T3, may help to differentiate Wellens' from PE

2018 Dr Smith's ECG Blog

115. Two cases of ST Elevation with Terminal T-wave Inversion - do either, neither, or both need reperfusion?

. Three serial troponins were undetectable. His serial ECGs did not change. He was discharged home. Learning Points: There are many causes of ST elevation, terminal T-wave inversions, and both simultaneously. Experience with the cases on this blog can teach you how to differentiate them. Wellens syndrome (or reperfusion in general) is an important cause of terminal T-wave inversions. See these cases below for examples. However, Wellens' syndrome includes resolution of chest pain and preservation of R (...) -waves, in addition to T-wave inversion. Thus, this second case would not be an example of Wellens' syndrome. Also see below for more cases of LV aneurysm morphology: References: T/QRS ratio to differentiate anterior STEMI from anterior LV aneurysm: 1. Papadakis M, Carre F, Kervio G, et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J. 2011;32(18):2304-2313. doi:10.1093/eurheartj

2018 Dr Smith's ECG Blog

116. If you had recorded an ECG during chest pain, what would it have shown?

. 1982 Apr;103(4 Pt 2):730-6. de Zwaan C et al. . Am Ht J 117(3): 657-665; March 1989. (Some later authors ignored Wellens own classification of "Pattern A" and called this "Type" B!! -- let's go back to Wellens' own classification) Here is an example of the mis classification: This is Wellens' syndrome: Since the patient had anginal chest pain that is now resolved, it meets the criteria for Wellens' syndrome ( criteria : resolved anginal chest pain, typical Wellens' waves in LAD distribution (...) with preserved R-waves, absence of LVH which can cause pseudoWellens' waves). See these posts for Wellens' mimics: Case continued Unlike many cases of Wellens' syndrome, this patient actually presented with active pain . So you are going to get to see what the ECG would have shown had you recorded one during pain! This was the first ECG (ECG #1) recorded during pain : This shows ST elevation and hyperacute T-waves in the LAD distribution. This is highly suspicious for acute LAD occlusion. It even meets STEMI

2018 Dr Smith's ECG Blog

117. Third Universal Definition of Myocardial Infarction

Multifactorial or indeterminate myocardial injury Heart failure Stress (Takotsubo) cardiomyopathy Severe pulmonary embolism or pulmonary hypertension Sepsis and critically ill patients Renal failure Severe acute neurological diseases, e.g. stroke, subarachnoid haemorrhage In?ltrative diseases, e.g. amyloidosis, sarcoidosis Strenuous exercise Expert Consensus Document 2555 Downloaded from by guest on 02 April 2019symptoms are not speci?c (...) for myocardial ischaemia. Accordingly, they may be misdiagnosed and attributed to gastrointestinal, neurological, pulmonary or musculoskeletal disorders. MI may occur with atypical symptoms—such as palpitations or cardiac arrest—or even without symptoms; for example in women, the elderly, diabetics, or post-operative and critically ill patients. 2 Careful evaluation of these patients is advised, especially when there is a rising and/or falling pattern of cardiac biomarkers. Clinical classi?cation

2012 European Society of Cardiology

118. Atrial Fibrillation

References. ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin-receptor blocker; HHD = hypertensive heart disease; CHD = coronary heart disease; HF = heart failure; LVH = left ventricular hypertrophy, NYHA = New York Heart Association. Antiarrhythmic agents are listed in alphabetical order within each treatment box. Minimal or no structural heart disease dronedarone/flecainide/ propafenone/sotalol amiodarone Significant structural heart disease Treatment of underlying condition (...) and Pathology, Nuclear Cardiology and Cardiac Computed Tomography, Pharmacology and Drug Therapy, Thrombosis, Valvular Heart Disease. The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press

2012 European Society of Cardiology

119. The Insulin-Only Bionic Pancreas Bridging Study

operation. This is a multicenter study of participants with type 1 diabetes, including pediatric and adults, who will manage their diabetes with the iLet bionic pancreas compared to usual care. Condition or disease Intervention/treatment Phase Type1diabetes Device: iLet Bionic Pancreas insulin-only configuration with Humalog or Novolog Device: iLet Bionic Pancreas insulin-only configuration with Fiasp Other: Usual care Other: Usual Care with insulin recommendations bionic pancreas Drug: iLet Bionic (...) : No Keywords provided by Steven J. Russell, MD, PhD, Massachusetts General Hospital: bionic pancreas closed loop insulin continuous glucose monitor Additional relevant MeSH terms: Layout table for MeSH terms Diabetes Mellitus, Type 1 Diabetes Mellitus Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases Autoimmune Diseases Immune System Diseases Insulin Insulin, Globin Zinc Insulin Lispro Insulin Aspart Insulin, Long-Acting Insulin degludec, insulin aspart drug combination Pancrelipase

2018 Clinical Trials

120. The Set-Point Study for Type 2 Diabetes: Evaluating the Use of an Insulin Only Bionic Pancreas System in Type 2 Diabetes

of age) subjects with type 2 diabetes in a random-order crossover study versus usual care with daily injections or an insulin pump. Condition or disease Intervention/treatment Phase Type 2 Diabetes Mellitus Device: Bionic Pancreas Other: Usual Care Not Applicable Detailed Description: The study will consist of two 7 day study arms: one usual care, and one insulin-only bionic pancreas at a set point of 100 mg/dl. The co-primary outcomes will be the mean Dexcom CGM glucose level and time <54 mg/dl (...) Classification III or IV History of TIA or stroke in the last 12 months Seizure disorder, history of any non-hypoglycemic seizure within the last two years, or ongoing treatment with anticonvulsants History of hypoglycemic seizures (grand-mal) or coma in the last year Untreated or inadequately treated mental illness (indicators would include symptoms such as psychosis, hallucinations, mania, and any psychiatric hospitalization in the last year), or treatment with anti-psychotic medications that are known

2018 Clinical Trials

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