Wellen’s Syndrome.

Wellen’s Syndrome occurs in patients who are at very high risk of an extensive anterior wall myocardial infarction (due to LAD artery stenosis) within the next few days to weeks.

Take a few moments to watch Janis (an Emergency Dept Clinical Nurse Specialist) show you how to quickly spot the ECG changes that may identify these patients who are  in imminent danger of sudden death.

Patients may present with complaints of recent chest pain (pressure, tightness or heaviness) that is typically related to activity and resolves with rest. It may radiate to the left arm and be accompanied by diaphoresis, nausea and/or fatigue.


A patient with Wellen’s Syndrome may present with the following ECG patterns:

  • Deeply-inverted or biphasic T waves in V2–3 (may extend to V1–6)
  • Isoelectric or minimally-elevated ST segment (< 1mm)
  • No precordial Q waves
  • Preserved precordial R wave progression
  • Recent history of angina
  • ECG pattern present in pain-free state
  • Normal or slightly elevated serum cardiac markers

There are 2 types of T wave ‘wells’:
Type A = Biphasic, with initial positivity & terminal negativity (25% of cases)
Type B = Deeply and symmetrically inverted (75% of cases)

Reference: Wellens syndrome [Internet]. Available from: http://lifeinthefastlane.com/ecg-library/wellens-syndrome/

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