Wellens syndrome

Wellens syndrome describes a pattern of electrocardiographic (ECG) changes, particularly deeply inverted or biphasic T waves in leads V2-V3, that is highly specific for critical, proximal stenosis of the left anterior descending (LAD) coronary artery. It is alternatively known as anterior, descending, T-wave syndrome. Typically when patients with Wellens syndrome present to the emergency department they are pain-free, and usually cardiac enzymes are normal or only slightly elevated. However, it is important to recognize the ECG patterns as these patients are at high risk for impending large anterior wall acute myocardial infarction. In fact, when Drs. De Zwaan, Wellens, and colleagues first identified the syndrome in the early 1980s, they noted that 75% of patients with these ECG findings went on to develop acute, anterior, wall, myocardial infarction within weeks if they were treated with only medical management. Definitive treatment typically involves cardiac catheterization with percutaneous coronary intervention (PCI) to relieve the occlusion