- Wellens’ syndrome is a pattern of inverted or biphasic T waves in V2-3 (in patients presenting with ischaemic chest pain) that is highly specific for critical stenosis of the left anterior descending artery.
- Patients may be pain free by the time the ECG is taken and have normally or minimally elevated cardiac enzymes; however, they are at extremely high risk for extensive anterior wall MI within the next 2-3 weeks.
There are two patterns of T-wave abnormality in Wellens’ syndrome:
- Type A Wellens’ T-waves are deeply and symmetrically inverted
- Type B Wellens’ T-waves are biphasic, with the initial deflection positive and the terminal deflection negative
Wellens’ Type A
Wellens’ Type B
Type A Wellens pattern:
- Deep T-wave inversions in the mid-precordial leads (V2-4) consistent with Wellens’ syndrome (type A).
Type B Wellens pattern:
- The biphasic T-waves in V1-3 are characteristic of Wellens’ syndrome (type B).
For more information on Wellens syndrome, read this excellent review article by Amal Mattu and colleagues from the American Journal of Emergency Medicine 2002.
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- Chan TC, Brady WJ, Harrigan RA, Ornato JP and Rosen PR. ECG in Emergency Medicine and Acute Care. Elsevier 2005
- Mattu A, Brady W. ECGs for the Emergency Physician 1, BMJ Books 2003.
- Mattu A, Brady W. ECGs for the Emergency Physician 2, BMJ Books 2008.
- Edhouse J, Brady WJ, Morris F. ABC of clinical electrocardiography: Acute myocardial infarction-Part II. BMJ. 2002; 324: 963-6. [full text]
- Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens’ syndrome. Am J Emerg Med. 2002 Nov;20(7):638-43 [pdf].
- Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice (6th edition), Saunders 2008.
- de Zwaan C, Bär 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. 1982 Apr;103(4 Pt 2):730-6. PMID: 6121481.