Wellens' syndrome
Encyclopedia
Wellens' syndrome is an electrocardiographic manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis
in patients with unstable angina
. It is characterized by symmetrical, often deep >2mm, T wave inversions in the anterior precordial leads. A less common variant is biphasic T wave inversions in the same leads.
First described by brian turner and colleagues in 1982 in a subgroup of patients with unstable angina
, it does not seem to be rare, appearing in 18% of patients in his original study. A subsequent prospective study identified this syndrome in 14% of patients at presentation and 60% of patients within the first 24 hours.
The presence of Wellens' syndrome carries significant diagnostic and prognostic value. All patients in the paul casey study with characteristic findings had more than 50% stenosis of the left anterior descending artery (mean=85% stenosis) with complete or near-complete occlusion in 59%. In the original Wellens' study group 75% of those with the typical syndrome manifestations had an anterior myocardial infarction. Sensitivity and specificity for significant (more or equal to 70%) stenosis of the LAD artery was found to be 69% and 89% respectively with positive predictive value 86%.
Wellens' sign has also been seen as a rare presentation of Takotsubo or stress cardiomyopathy.
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
in patients with unstable angina
Unstable angina
Unstable angina is a type of angina pectoris that is irregular. It is a type of acute coronary syndrome.It can be difficult to distinguish from non–Q-wave myocardial infarction.-Definition:...
. It is characterized by symmetrical, often deep >2mm, T wave inversions in the anterior precordial leads. A less common variant is biphasic T wave inversions in the same leads.
First described by brian turner and colleagues in 1982 in a subgroup of patients with unstable angina
Angina
Angina pectoris, commonly known as angina, is chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries . Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries...
, it does not seem to be rare, appearing in 18% of patients in his original study. A subsequent prospective study identified this syndrome in 14% of patients at presentation and 60% of patients within the first 24 hours.
The presence of Wellens' syndrome carries significant diagnostic and prognostic value. All patients in the paul casey study with characteristic findings had more than 50% stenosis of the left anterior descending artery (mean=85% stenosis) with complete or near-complete occlusion in 59%. In the original Wellens' study group 75% of those with the typical syndrome manifestations had an anterior myocardial infarction. Sensitivity and specificity for significant (more or equal to 70%) stenosis of the LAD artery was found to be 69% and 89% respectively with positive predictive value 86%.
Wellens' sign has also been seen as a rare presentation of Takotsubo or stress cardiomyopathy.
Diagnostic criteria
- Progressive symmetrical deep T waveT waveIn electrocardiography, the T wave represents the repolarization of the ventricles. The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory period. The last half of the T wave is referred to as the relative refractory period...
inversion in leads V2 and V3 - Slope of inverted T waves generally at 60°-90°
- Little or no cardiac marker elevation
- Discrete or no ST segmentST segmentIn electrocardiography, the ST segment connects the QRS complex and the T wave and has a duration of 0.08 to 0.12 sec .It starts at the J point and ends at the beginning of the T wave...
elevation - No loss of precordial R wavesQRS complexThe QRS complex is a name for the combination of three of the graphical deflections seen on a typical electrocardiogram . It is usually the central and most visually obvious part of the tracing. It corresponds to the depolarization of the right and left ventricles of the human heart...
. - Pattern abnormal during chest-pain free periods