Eponymous Cardiac Syndromes

SyndromeECGPathologyClinical SignificanceImages / References
WellensProximal critical stenosis of LAD arterySymmetrical deeply inverted T waves in V2-3 or Biphasic in V2-3 with minimal ST elevation.Changes occur in pain free state and normalise when painAcute anterior MI if untreated
BrugadaSodium channelopathy.40% familial (autosomal dominant)RBBB with ST elevation in V1-3. Convex and concave ST variantsRisk of sudden death, mandates urgent ICD
Wolff-Parkinson WhitePre-excitation syndrome.Re-entrant bundle of AV tissue distant to AV node.Short PR interval; Prolonged QRS and slurred upstroke of QRS complex (Delta wave).“Type A” shows positive QRS in V1 (LV accessory). Upright positive delta wave in all precordial leads with a resultant R greater than S amplitude in lead V1“Type B” shows negative QRS in V1(RV accessory). Predominantly negative delta wave and QRS complex in leads V1 and V2 and becomes positive in transition to the lateral leads resembling LBBB.Risk of Atrial arrhythmias being transmitted abherrantly causing VF or VT.Requires ablation of pathwayClinical Case WPW 001Wolff-Parkinson-White Type AWolff-Parkinson-White Type B
Mobitz IIA-V blockPR of constant intervalConstant PR interval until P waved dropped with P-P interval twice normalLikely to progress to CHB 
WenckebachA-V blockPR of increasing interval Lengthening PR interval until P waved dropped with P-P interval variable. Grouped beats Need follow up but less likely to progress to CHB
Lown-Ganong-LevinePre- excitation syndromeRe-entrant bundle of AV tissue close to AV node . Accessory pathway is down James fibres.No Delta wave as conduction normal down Bundle of HisRisk of AF being transmitted abherrantly causing VF or VT.Requires ablation of pathway as WPW 
Romano -WardInherited Long QT syndrome (Autosomal dominant)Defect of Na and K channels.Not associated with deafnessLong QT, T wave alternans, notched T wave, R on T phenomenon, TorsadesRisk of Torsades. Electrolyte optimisation, may require ICD 
Lange–Neilson and JervelleInherited Long QT syndrome. Autosomal recessive defect of Na and K channels.Associated with neurosensorial deafness.Long QT , T wave alternans, notched T wave, R on T phenomenon, TorsadesRisk of Torsades.Electrolyte optimisation, may require ICDAssociated with syncope, and sudden death 
Sgarbossa criteriaDerived from GUSTO 1 trial to identify MI in paced or LBBB patientsST elevation >1mm concordant with QRS complex (5pts), ST depression >1mm in V1-3 (3pts), ST elevation >5mm discordant with QRS 2 points. >3 points consistent with MIHelp risk stratify patients with chronic LBBB presenting with ACS symptoms 
Tako TsuboCardiomyopathy with hypertrophic LV inferior and Hypotrophic superior wall (Octopus jar heart)ECG changes as MI but usually brought on by stressful eventNormal angiogram but require cardiology follow upTakotsubo
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