SAQ 252 – Cardiology – Wellens syndrome

Question 5. Wellens syndrome.

a. Significance

• The pattern is consistent with Wellens syndrome.
• It is highly specific for critical left-anterior-descending coronary-artery stenosis.
• There is a very high risk of extensive anterior myocardial infarction within days to weeks.
• Urgent invasive angiography and intervention are required.
• Medical management alone has poor outcomes.
• Stress testing may precipitate myocardial infarction or cardiac arrest and should be avoided.

b. Diagnostic features

• Recent history of angina.
• Characteristic ECG pattern during a pain-free period.
• Deeply inverted or biphasic T waves in V2-V3, potentially extending from V1 to V6.
• Isoelectric or minimally elevated ST segment below 1 mm.
• No precordial Q waves.
• Preserved precordial R-wave progression.
• Normal or only slightly elevated cardiac biomarkers.