LITFL | ECG Library | Wellens’ Syndrome

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 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 1 274x300 T wave wellens1 1 256x300 T wave

Wellens’ Type B

Wellens 2 2 T wave Wellens 2 T wave

Example ECGs

Example 1

Type A Wellens pattern:

  • Deep T-wave inversions in the mid-precordial leads (V2-4) consistent with Wellens’ syndrome (type A).

 

Example 2

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.

LITFL Blog Posts

Related Topics

Further Reading

References

Print Friendly
About Edward Burns

Ed Burns is an Emergency Medicine Registrar, originally from England, but now based in Western Australia. A self-described ECG nerd, Ed is the force behind the ECG library and ECG Exigency series - Read Posts + Edward Burns | Contact