Wellens' syndrome

(Redirected from Wellens' sign)
Jump to navigation Jump to search

WikiDoc Resources for Wellens' syndrome

Articles

Most recent articles on Wellens' syndrome

Most cited articles on Wellens' syndrome

Review articles on Wellens' syndrome

Articles on Wellens' syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Wellens' syndrome

Images of Wellens' syndrome

Photos of Wellens' syndrome

Podcasts & MP3s on Wellens' syndrome

Videos on Wellens' syndrome

Evidence Based Medicine

Cochrane Collaboration on Wellens' syndrome

Bandolier on Wellens' syndrome

TRIP on Wellens' syndrome

Clinical Trials

Ongoing Trials on Wellens' syndrome at Clinical Trials.gov

Trial results on Wellens' syndrome

Clinical Trials on Wellens' syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Wellens' syndrome

NICE Guidance on Wellens' syndrome

NHS PRODIGY Guidance

FDA on Wellens' syndrome

CDC on Wellens' syndrome

Books

Books on Wellens' syndrome

News

Wellens' syndrome in the news

Be alerted to news on Wellens' syndrome

News trends on Wellens' syndrome

Commentary

Blogs on Wellens' syndrome

Definitions

Definitions of Wellens' syndrome

Patient Resources / Community

Patient resources on Wellens' syndrome

Discussion groups on Wellens' syndrome

Patient Handouts on Wellens' syndrome

Directions to Hospitals Treating Wellens' syndrome

Risk calculators and risk factors for Wellens' syndrome

Healthcare Provider Resources

Symptoms of Wellens' syndrome

Causes & Risk Factors for Wellens' syndrome

Diagnostic studies for Wellens' syndrome

Treatment of Wellens' syndrome

Continuing Medical Education (CME)

CME Programs on Wellens' syndrome

International

Wellens' syndrome en Espanol

Wellens' syndrome en Francais

Business

Wellens' syndrome in the Marketplace

Patents on Wellens' syndrome

Experimental / Informatics

List of terms related to Wellens' syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Wellen's syndrome; Wellen's Ts; Wellen's T waves; Wellen's sign; Wellens' Ts; Wellens' T waves; Wellens' sign; Wellen syndrome; Wellen Ts; Wellen T waves; Wellen sign

Overview

Wellens' syndrome (or sign, or occasionally warning) 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.[1]

Historical Perspective

The syndrome was first described by Hein J. J. Wellens and colleagues in 1982 in a subgroup of patients with unstable angina.[2]

Causes

Wellens' syndrome is associated with atherothrombotic occlusion of the left anterior descending artery. Wellens' sign has also been seen as a rare presentation of Takotsubo or stress cardiomyopathy.

Epidemiology and Demographics

The syndrome is present in 16% of patients in the orginal description [3] and in 14% of patients at presentation in a prospective study and in 60% of patients within the first 24 hours.[4]

Natural History, Prognosis and Complications

The presence of Wellens' syndrome carries significant diagnostic and prognostic value. All patients in the De Zwann's 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%.[5]

Diagnosis

Electrocardiographic Criteria

Electrocardiographic Examples

Shown above is the EKG of a 69-year-old black male with Wellens' sign.


Coronary angiogram showing tight, critical stenosis (95%) of the proximal LAD in a patient with Wellens' Warning
Coronary angiogram showing tight, critical stenosis (95%) of the proximal LAD in a patient with Wellens' Warning

Shown above is a coronary angiogram showing a tight, critical stenosis in the proximal left anterior descending coronary artery (left); After placement of a bare-metal stent (right). Wellens' warning.


Shown above is the EKG of a patient with Wellens' sign during an episode of chest pain.


Shown above is the EKG of the same patient after the episode of chest pain had resolved. Despite resolution of the chest pain, note the persistent biphasic T waves in leads V2 and V3.

References

  1. Tandy, TK (1999). "Wellens' syndrome". Annals of Emergency Medicine. 33 (3): 347–351. doi:10.1016/S0196-0644(99)70373-2. PMID 10036351. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  2. de Zwaan, C (1982). "Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction". American Heart Journal. 103 (4): 730–736. doi:10.1016/0002-8703(82)90480-X. PMID 6121481. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  3. de Zwaan, C (1982). "Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction". American Heart Journal. 103 (4): 730–736. doi:10.1016/0002-8703(82)90480-X. PMID 6121481. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  4. de Zwaan, C (1989). "Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery". American Heart Journal. 117 (3): 657–665. doi:10.1016/0002-8703(89)90742-4. PMID 2784024. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)
  5. Haines, DE (1983). "Anatomic and prognostic significance of new T-wave inversion in unstable angina". American Journal of Cardiology. 52 (1): 14–18. doi:10.1016/0002-9149(83)90061-9. PMID 6602539. Unknown parameter |month= ignored (help); Unknown parameter |coauthors= ignored (help)