Wellens’ Syndrome

• 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 1 Wellens’ T-waves are deeply and symmetrically inverted
• Type 2 Wellens’ T-waves are biphasic, with the initial deflection positive and the terminal deflection negative

Wellens’ Type 1

Wellens’ Type 2

Example ECGs

Example 1

Type 1 Wellens Syndrome:

• Deep T-wave inversions in the mid-precordial leads (V2-4) consistent with type 1 Wellens syndrome.

Example 2

Type 2 Wellens Syndrome:

• The biphasic T-waves in V1-3 are characteristic of type 2 Wellens syndrome.

For more information on Wellens syndrome, read this excellent review article by Amal Mattu and colleagues from the American Journal of Emergency Medicine 2002.

LITFL Blog Posts

• “What is Wellens’ syndrome?” by James Winton.
• “Pain free and in VT?” - an ECG conundrum from the ECG Exigency series.

Related Topics

• Anterior STEMI
• LMCA occlusion
• Myocardial ischemia

Further Reading

• ECG BASICS – Waves, Intervals, Segments and Clinical Interpretation
• ECG CLINICAL CASES – Your favourite ECG’s placed in clinical context with a challenging Q&A approach
• ECG and Cardiology Eponymous Syndromes – Cheats guide to eponymous emancipation
• ECG Reference Sites on the WEB – the best of the rest

Author Credits

References

• 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.