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Wellens Syndrome

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121. Biphasic T-waves in a Middle-Aged Male with Vomiting

of view can we say that Wellens' waves are the evolution of an early ST elevation? Thanks in advance. Wellens' waves are reperfusion T-waves. When STEMI is reperfused, one of the first signs of reperfusion is the downward turn of the end of the T-wave. In Wellen's syndrome, there is absence of recording during chest pain, when one would have found STEMI. The artery reperfuses, the pain goes away, and the first recording you get is the terminal T-wave inversion. If you wait longer, you'll get pattern B (...) Biphasic T-waves in a Middle-Aged Male with Vomiting Dr. Smith's ECG Blog: Biphasic T-waves in a Middle-Aged Male with Vomiting Thursday, November 10, 2016 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: Wellen's waves are always Up-Down T-waves, not Down-Up T-waves as here. Down-Up T-waves in V2 and V3 have only two causes: 1) posterior MI with some

2016 Dr Smith's ECG Blog

122. A Patient with Ischemic symptoms and a Biventricular Pacemaker

manifest in reperfusion of VPR cases. Here is the next day ECG: Deeper T-wave inversion, evolving just like in Wellens' syndrome (which is a condition of reperfusion of the LAD after brief occlusion). Learning Point: STEMI may be diagnosed in VPR!! We are starting a large study of this, at multiple sites. We'll see how well the Modified Sgarbossa Criteria work for VPR. has some great comments on this post here: If EVER you wanted to learn more about how you may sometimes see definitive evidence (...) not so wise) that states that no further interpretation is possible in VPR. In this case, the VPR beats show the STEMI. The Non-VPR beats do NOT show it. Furthermore, the VPR showed reperfusion changes after PCI: There is electrical alternans of unknown etiology. There is r esolution of most ST elevation (indicating reperfusion) and T-wave inversion ("Wellens' waves, reperfusion T-waves) in V2 and V3, and also in half of the V5 and V6 waves, depending on the QRS. Thus, even T-wave inversion may

2016 Dr Smith's ECG Blog

123. HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials

. Patients who do not meet these criteria need to be evaluated quite differently in terms of suitability for ICD therapy. The requirement to delay ICD implantation for 40 days after presentation is not applicable if a clear diagnosis of acute MI is not established. This mandatory waiting period should not be imposed on patients who would otherwise qualify for an ICD for either primary or secondary prevention. Figure 2. Ischemic and nonischemic causes of abnormal troponin. ACS = acute coronary syndrome

2014 American Heart Association

124. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

: Recommendations e240 7.5. Hyperthyroidism: Recommendations e241 7.6. Acute Noncardiac Illness e241 7.7. Pulmonary Disease: Recommendations e242 7.8. WPW and Pre-Excitation Syndromes: Recommendations e242 7.9. Heart Failure: Recommendations e243 7.10. Familial (Genetic) AF: Recommendation e244 7.11. Postoperative Cardiac and Thoracic Surgery: Recommendations e244 Evidence Gaps and Future Research Directions e244 References e245 Appendix 1. Author Relationships With Industry and Other Entities (Relevant) e258

2014 American Heart Association

125. Royal Flying Doctor Service Western Operations Clinical manual part 1.Clinical guidelines

i. ECG ? ST elevation in aVR ± aVL ? Lesser ST elevation in V1 ? Marked ST depression in inferior leads ± left anterior fascicular block ii. May present with cardiogenic shock, significant ventricular arrhythmias or cardiac arrest iii. Very high mortality rate b) Total occlusion of proximal left anterior descending coronary artery (LAD) (Wellen’s Syndrome) ? ECG – prominent T wave inversion in V1-V6. (mostly V1-V4) RFDS Western Operations Version 6.0 Clinical Manual Issue Date: January 2013 Part (...) (Paediatric) 5 1.5 The Deteriorating Patient 7 2 CARDIOVASCULAR 1 2.1 Acute Coronary Syndromes 1 2.2 Acute Pulmonary Oedema 6 2.3 Cardiac Arrhythmias 8 3 ENDOCRINE 1 3.1 Diabetic Ketoacidosis 1 3.2 Hypoglycaemia 3 3.3 Hypocalcaemia 5 4 GASTROINTESTINAL 1 4.1 Acute Pancreatitis 1 4.2 Haematemesis and Melaena 3 4.3 Intestinal Obstruction 5 5 GENITOURINARY 1 5.1 Acute / Chronic Renal Failure 1 6 INFECTIOUS DISEASES 1 6.1 Bacterial Meningitis 1 6.2 Meningococcal Infection 3 6.3 Tuberculosis 5 6.4 Meliodosis 6

2014 Clinical Practice Guidelines Portal

126. Diabetes, Pre-Diabetes and Cardiovascular Diseases

. . . . . . . . . . . . . . . . . . . . .3049 4.8 The metabolic syndrome . . . . . . . . . . . . . . . . . . . . .3049 4.9 Endothelial progenitor cells and vascular repair . . . . . . .3049 4.10 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3049 5. Cardiovascular risk assessment in patients with dysglycaemia . .3049 5.1 Risk scores developed for people without diabetes . . . .3049 5.2 Evaluation of cardiovascular risk in people with pre- diabetes (...) -angiotensin-aldosterone system 3064 7.1.3. Lipid-lowering drugs . . . . . . . . . . . . . . . . . . . . .3065 7.1.4. Nitrates and calcium channel blockers . . . . . . . . . .3065 7.1.5. Ivabradine . . . . . . . . . . . . . . . . . . . . . . . . . . . .3065 7.1.6. Antiplatelet and antithrombotic drugs (see also Sections 6.5 and 7.2) . . . . . . . . . . . . . . . . . . . . . . . . .3065 7.1.7. Glucose control in acute coronary syndromes . . . .3065 7.1.8. Gaps in knowledge

2013 European Society of Cardiology

127. Heart Disease and Stroke Statistics?2016 Update

. High Blood Pressure e135 10. Diabetes Mellitus e148 11. Metabolic Syndrome e162 12. Chronic Kidney Disease e178 Cardiovascular Conditions/Diseases 13. Total Cardiovascular Diseases e184 14. Stroke (Cerebrovascular Disease) e204 15. Congenital Cardiovascular Defects and Kawasaki Disease e235 16. Disorders of Heart Rhythm e247 17. Sudden Cardiac Arrest e268 18. Subclinical Atherosclerosis e279 19. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris e292 20. Cardiomyopathy and Heart (...) % of all childhood diabetes mellitus. Diabetes mellitus is associated with reduced longevity; men and women with diabetes mellitus live an average of 7.5 and 8.2 years less, respectively, than their counterparts without diabetes mellitus. Metabolic Syndrome (Chapter 11) From 1999 to 2010, the age-adjusted national prevalence of metabolic syndrome in the United States peaked (in 2001–2002) and began to fall. This is attributable to decreases in the age-adjusted prevalence among women and no change

2014 American Heart Association

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

with a sensitivity of 89% and specificity of 98% in comparison to the MMSE. One study has evaluated its performance in an inpatient population and reported it correlated well with the MMSE and took about nine minutes to perform. 59 Physicians preferred the MMSE to the RUDAS because of its greater familiarity. Level I Level II Level II Using technicians to screen for geriatric syndromes in the ED One survey study reported the acceptability and usefulness of technicians (paid medical student research assistants (...) ) to screen for cognitive dysfunction, fall risk, or functional decline in patients older than 65 years presenting to the ED. Most survey respondents (Emergency Medicine [EM] nurses and physicians) indicated that an individual dedicated to screening older adults for geriatric syndromes would benefit overall from clinical care without negatively impacting patient flow. 60 Level IV 17Intervention Evidence of effectiveness Strength of the Evidence Base Screening tools for CI in the Emergency Department (ED

2013 Sax Institute Evidence Check

129. Case Report: Diffuse T wave inversions as initial electrocardiographic evidence in acute pulmonary embolism (PubMed)

inversions with serial troponin elevation. There was initial concern for Wellen's syndrome but was finally diagnosed as acute PE. This case underscores the necessity of vigilance and a lower threshold for PE work up even in patients presenting as acute coronary syndrome.

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2018 F1000Research

130. ECG Quiz – Answer

waves are possibly originating from the left atrium ( left atrial rhythm ). In addition there prolongation of the QT interval (note the wide and splayed T wave in aVR) and biphasic T waves in anterior leads giving a suggestion of Wellens syndrome. Wellens syndrome is indicative of tight stenosis of proximal left anterior descending coronary artery. Lateral leads show Q waves. QRS axis is a bit leftward, suggesting left anterior hemiblock. Share this: Related Related Posts | Apr 23, 2012 | Dec 18

2018 Cardiophile MD blog

131. Third Universal Definition of Myocardial Infarction

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2563 Public policy implications of the adjustment of the MI de?nition 2563 Global perspectives of the de?nition of myocardial infarction . . 2564 Con?icts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2564 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2564 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2564 Abbreviations and acronyms ACCF American College of Cardiology Foundation ACS acute coronary syndrome AHA (...) be used as a proxy for the prevalence of CAD in that population. The term ‘myocardial infarction’ may have major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world and it is an outcome measure in clinical trials, obser- vational studies and quality assurance programmes. These studies and programmes require a precise and consistent de?nition of MI. In the past, a general consensus existed for the clinical syndrome

2012 European Society of Cardiology

132. Atrial Fibrillation

College of Cardiology Foundation ACCP American College of Chest Physicians ACS acute coronary syndrome ACT Atrial arrhythmia Conversion Trial ADONIS American–Australian–African trial with DronedarONe In atrial ?brillation or ?utter for the maintenance of Sinus rhythm AF atrial ?brillation AHA American Heart Association ANDROMEDA ANtiarrhythmic trial with DROnedarone in Moderate-to-severe congestive heart failure Evaluating morbidity DecreAse APHRS Asia Paci?c Heart Rhythm Society aPTT activated (...) with CV risk factors 400 mg b.i.d. Y es 1. Co-primary = composite of stroke, MI, SE, CV death 2. Co-primary = composite of ?rst unplanned CV hospitalization or death Median, 3.5 Stopped early because of excess events in the dronedarone group: total mortality n = 25 in dronedarone group, n = 13 in placebo group; cardiovascular mortality n = 21 in dronedarone group, n = 10 in placebo group Only 64 of planned 844 outcome events occurred ACS¼ acute coronary syndrome; ADONIS¼ American-Australian-African

2012 European Society of Cardiology

133. Research and Reviews in the Fastlane 125

evidence). Recommended by Lauren Westafer Cardiology Macias M et al. The electrocardiogramin the ACS patient: high-risk electrocardiographic presentations lacking anatomically oriented ST-segment elevation. Am J Emerg Med 2015. PMID: This review focuses on the 5 of the more common, yet lesser known, high-risk ECG patterns in the ACS patient that you gotta know: 1. 1st Diagonal Branch of LAD Artery 2. de Winter Presentation 3. Left Main Coronary Artery Occlusion 4. WellensSyndrome 5. Posterior Wall MI

2016 Life in the Fast Lane Blog

134. Articles of the month (May 2017)

are good, but have a plan to manage this awareness. Wellen’s syndrome Morris N, Howard L. BET 1: In patients with suspected acute coronary syndrome, does Wellens’ sign on the electrocardiograph identify critical left anterior descending artery stenosis? Emergency medicine journal 34(4):264-266. 2017. PMID: This review looks at 6 papers trying to answer the question: in adult patients with suspected acute coronary syndrome, does Wellen’s sign on the ECG identify critical stenosis of the left anterior (...) surrogate. The heterogeneity here doesn’t allow for a single estimate, but if you identify Wellen’s syndrome, there is a high likelihood (somewhere between 50-90% in these studies) that the patient has a >70% LAD lesion. The thing to remember is that Wellen’s is not an ECG finding alone, but rather an ECG finding in combination with history. Part of the definitions of Wellen’s syndrome is a recent history of angina. Bottom line: We should know what Wellen’s syndrome is and watch for it ACEP policy

2017 First10EM

136. Exercise Standards for Testing and Training

, and during this time additional purposes for testing have evolved. Exercise testing now is used widely for the following: Detection of coronary artery disease (CAD) in patients with chest pain (chest discomfort) syndromes or potential symptom equivalents Evaluation of the anatomic and functional severity of CAD Prediction of cardiovascular events and all-cause death Evaluation of physical capacity and effort tolerance Evaluation of exercise-related symptoms Assessment of chronotropic competence (...) , or exercise physiologist or specialist) for testing apparently healthy younger people (<40 years of age) and those with stable chest pain syndromes. Recent recommendations permit additional flexibility with regard to supervision personnel. Possibly with the exception of young, apparently healthy individuals (eg, exercise testing of athletes), a physician should be immediately available during all exercise tests. For additional details about supervision and interpretation of exercise tests, reference

2013 American Heart Association

137. Third Universal Definition of Myocardial Infarction

in clinical trials, observational studies and quality assurance programmes. These studies and programmes require a precise and consistent definition of MI. In the past, a general consensus existed for the clinical syndrome designated as MI. In studies of disease prevalence, the World Health Organization (WHO) defined MI from symptoms, ECG abnormalities and cardiac enzymes. However, the development of ever more sensitive and myocardial tissue-specific cardiac biomarkers and more sensitive imaging (...) hypertrophy (LVH), left bundle branch block (LBBB), Brugada syndrome, stress cardiomyopathy, and early repolarization patterns. Prolonged new ST-segment elevation (e.g. >20 min), particularly when associated with reciprocal ST-segment depression, usually reflects acute coronary occlusion and results in myocardial injury with necrosis. As in cardiomyopathy, Q waves may also occur due to myocardial fibrosis in the absence of CAD. ECG abnormalities of myocardial ischaemia or infarction may be inscribed

2012 American Heart Association

138. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

the writing committee out of compliance with the minimum 50% no relevant RWI requirement. ACS indicates acute coronary syndromes; DSMB, data safety monitoring board; NHLBI, National Heart, Lung, and Blood Institute; NIH, National Institutes of Health; and PI, principal investigator. In an effort to maintain relevance at the point of care for practicing physicians, the Task Force continues to oversee an ongoing process improvement initiative. As a result, in response to pilot projects, several changes (...) coronary syndromes, percutaneous coronary intervention, coronary artery bypass graft, myocardial infarction, ST-elevation myocardial infarction, coronary stent, revascularization, anticoagulant therapy, antiplatelet therapy, antithrombotic therapy, glycoprotein IIb/IIIa inhibitor therapy, pharmacotherapy, proton-pump inhibitor, implantable cardioverter-defibrillator therapy, cardiogenic shock, fibrinolytic therapy, thrombolytic therapy, nitrates, mechanical complications, arrhythmia, angina, chronic

2012 American Heart Association

139. Heart Disease and Stroke Statistics?2012 Update

. . . . . . . . . . . . . . . . . . . . .e45 Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris . . . . . . . . .e54 Stroke (Cerebrovascular Disease) . . . . . . . . . . . . . . . . . . . . . . . . . . . .e68 High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .e88 Congenital Cardiovascular Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . .e97 Cardiomyopathy and Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . .e102 Disorders of Heart Rhythm (...) and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . .e152 Risk Factor: Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e160 End-Stage Renal Disease and Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . .e170 Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e175 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e180 Quality of Care

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2012 American Heart Association

140. 2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

1.2. Document Review and Approval e288 1.3. Methodology and Evidence e288 2. Indications for Pacing e290 2.1. Pacing for Bradycardia Due to Sinus and Atrioventricular Node Dysfunction e290 2.1.1. Sinus Node Dysfunction e290 2.1.2. Acquired Atrioventricular Block in Adults e291 2.1.3. Chronic Bifascicular Block e293 2.1.4. Pacing for Atrioventricular Block Associated With Acute Myocardial Infarction e294 2.1.5. Hypersensitive Carotid Sinus Syndrome and Neurocardiogenic Syncope e295 2.2. Pacing (...) for Specific Conditions e296 2.2.1. Cardiac Transplantation e297 2.2.2. Neuromuscular Diseases e297 2.2.3. Sleep Apnea Syndrome e297 2.2.4. Cardiac Sarcoidosis e297 2.3. Prevention and Termination of Arrhythmias by Pacing e298 2.3.1. Pacing to Prevent Atrial Arrhythmias e298 2.3.2. Long-QT Syndrome e298 2.3.3. Atrial Fibrillation (Dual-Site, Dual-Chamber, Alternative Pacing Sites) e299 2.4. Pacing for Hemodynamic Indications e299 2.4.1. Cardiac Resynchronization Therapy( UPDATED ) e299 2.4.2. Obstructive

2012 American Heart Association

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