Wellens syndrome (´´widowmaker´´, ´´LAD coronary syndrome´´) is a pattern of T wave abnormalities in precordial leads, which is highly associated with a critical stenosis of the left anterior descending artery (LAD).
Its natural progression leads to anterior wall MI within the next few days or weeks. This progression is rapid, so it is very important to recognise this pattern early.
Characteristic T-wave changes (symmetric and deeply inverted T waves or biphasic T waves in leads V2 and V3) in a pain free state
Recent history of AP
Normal or slightly elevated cardiac markers
Absence of precordial Q waves, isoelectric or minimal (< 1mm) ST elevation, and normal precordial R wave progression
There are two patterns of T-wave abnormality in Wellens syndrome:
Type A – Biphasic, with initial positivity and terminal negativity
Type B – Deeply and symmetrically inverted
T wave changes can evolve over time from Type A to Type B pattern
ECG 1 Wellens sign - biphasic T waves in V2-V4 leads in a patient with a critical stenosis of proximal LAD
ECG 2 Wellens sign in another patient
Benjamin B Mattingly, Kevin M Gentile, Erik D Schraga. Wellens Syndrome: Background, Pathophysiology, Etiology. Diseases & Conditions - Medscape Reference [online]. https://emedicine.medscape.com/article/1512230-overview
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Al-Assaf O, Abdulghani M, Musa A, AlJallaf M. Wellen's Syndrome: The Life-Threatening Diagnosis. Circulation. 2019 Nov 26;140(22):1851-1852. doi: 10.1161/CIRCULATIONAHA.119.043780. Epub 2019 Nov 25. PMID: 31765255.
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