It is important to understand that Wellens’ syndrome is not just an ECG sign alone but ECG signs in context with the clinical picture illustrated below.
- Wellens' with biphasic T waves and - Figure 1
- Wellens' symmetrically inverted and deep T waves – Figure 2
Diagnostic criteria for Wellens:
- Signifies critical left anterior descending artery occlusion and high risk for extensive myocardial infarction
- About 75% of patient with this ECG finding have AW STEMI within < 2 weeks.
- These patients may or may not have active chest pain at presentation and the cardiac enzymes may be normal or elevated
- These patients are not fit for stress tests as they are too high risk for a large myocardial infarct
- Watch out for Wellen's waves routinely (esp biphasic T waves)
- This subset of patients may not have chest pain and normal cardiac biomarkers.
- Don't send them for a stress test.
- Discuss with Cardiology for urgent/emergent PCI
Dr. Akshay Kumar MBBS, MRCP
Department of Emergency Medicine
All India Institue of Medical Sciences
Edited by: Lakshay Chanana