Wellens' syndrome explained

Wellens' syndrome
Synonyms:Wellens' sign, Wellens' warning, Wellens' waves
Field:Cardiology
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Wellens' syndrome is an electrocardiographic manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis in people with unstable angina. Originally thought of as two separate types, A and B, it is now considered an evolving wave form, initially of biphasic T wave inversions and later becoming symmetrical, often deep (>2 mm), T wave inversions in the anterior precordial leads.[1]

First described by Hein J. J. Wellens and colleagues in 1982 in a subgroup of people with unstable angina,[2] it does not seem to be rare, appearing in 18% of patients in his original study. A subsequent prospective study identified this syndrome in 14% of patients at presentation and 60% of patients within the first 24 hours.[3]

The presence of Wellens' syndrome carries significant diagnostic and prognostic value. All people 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 a positive predictive value of 86%.[4]

Wellens' sign has also been seen as a rare presentation of Takotsubo cardiomyopathy or stress cardiomyopathy.__TOC__

Diagnosis

The diagnosis is done via:

Notes and References

  1. Tandy . TK . Bottomy DP . Lewis JG . Wellens' syndrome . Annals of Emergency Medicine . 33 . 3 . 347–351 . March 1999 . 10036351 . 10.1016/S0196-0644(99)70373-2.
  2. de Zwaan . C . Bär FW . Wellens HJJ . 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 . April 1982 . 6121481 . 10.1016/0002-8703(82)90480-X.
  3. de Zwaan . C . Bär FW . Janssen JH . 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 . March 1989 . 2784024 . 10.1016/0002-8703(89)90742-4. etal.
  4. Haines . DE . Raabe DS . Gundel WD . Wackers FJ . Anatomic and prognostic significance of new T-wave inversion in unstable angina . American Journal of Cardiology . 52 . 1 . 14–18 . July 1983 . 6602539 . 10.1016/0002-9149(83)90061-9.