Wellens Syndrome Abel David Wellens Syndrome is a pattern in anterior leads, V2 and V3 Deeply inverted or biphasic T-waves Highly specific for critical stenosis of left anterior descending (LAD) coronary artery In Wellens study, patients had % occlusion At high risk for anterior wall MI May be pain free when the ECG is taken Have normally or minimally elevated cardiac enzymes Indicates a critical LAD stenosis Patients usually require invasive therapy Do poorly with medical management May suffer MI or cardiac arrest if inappropriately stress tested Two patterns of T-wave abnormality Type A: biphasic Type B: deeply, symmetrically inverted Wellens Type A Biphasic with initial positivity and terminal negativity 25% of cases Wellens Type A TT T T Wellens Type B Deeply and symmetrically inverted 75% of cases Wellens Type B T T T T 53 y/o M hx of CP and troponins negative Cath lab activation necessary This patient needs PCI Avoid stress testing Differential diagnoses for Wellens syndrome Other conditions that produce precordial T-wave inversion: PE, RBBB, RVH, LVH, hypertrophic cardiomyopathy, increased ICP, normal pediatric ECG, persistent juvenile T wave pattern, Brugada syndrome, hypokalemia