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| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Wellens' syndrome}} |
| {{CMG}} | | {{CMG}} |
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| {{SK}} 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
| | ==[[Wellens' syndrome overview|Overview]]== |
| ==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.<ref>{{cite journal | last = Tandy | first = TK |coauthors = Bottomy DP, Lewis JG | title = Wellens' syndrome | journal = Annals of Emergency Medicine | volume = 33 | issue = 3 | pages = 347–351 | year = 1999 | month = March | pmid = 10036351 | doi = 10.1016/S0196-0644(99)70373-2}}</ref>
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| ==Historical Perspective== | | ==[[Wellens' syndrome historical perspective|Historical Perspective]]== |
| The syndrome was first described by [[Hein_Wellens | Hein J. J. Wellens]] and colleagues in 1982 in a subgroup of patients with [[unstable angina]].<ref>{{cite journal | last = de Zwaan | first = C | coauthors = Bär FW, Wellens HJJ | title = Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction | journal = American Heart Journal | volume = 103 | issue = 4 | pages = 730–736 | year = 1982 | month = April | pmid = 6121481 | doi = 10.1016/0002-8703(82)90480-X}}</ref>
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| ==Causes== | | ==[[Wellens' syndrome classification|Classification]]== |
| 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]].
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| ==Epidemiology and Demographics== | | ==[[Wellens' syndrome pathophysiology|Pathophysiology]]== |
| The syndrome is present in 16% of patients in the orginal description <ref>{{cite journal | last = de Zwaan | first = C | coauthors = Bär FW, Wellens HJJ | title = Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction | journal = American Heart Journal | volume = 103 | issue = 4 | pages = 730–736 | year = 1982 | month = April | pmid = 6121481 | doi = 10.1016/0002-8703(82)90480-X}}</ref> and in 14% of patients at presentation in a prospective study and in 60% of patients within the first 24 hours.<ref>{{cite journal | last = de Zwaan | first = C | coauthors = Bär FW, Janssen JH, et al. | title = Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery | journal = American Heart Journal | volume = 117 | issue = 3 | pages = 657–665 | year = 1989 | month = March | pmid = 2784024 | doi = 10.1016/0002-8703(89)90742-4}}</ref>
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| ==Natural History, Prognosis and Complications== | | ==[[Wellens' syndrome causes|Causes]]== |
| 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%.<ref>{{cite journal | last = Haines | first = DE | coauthors = Raabe DS, Gundel WD, Wackers FJ | title = Anatomic and prognostic significance of new T-wave inversion in unstable angina | journal = American Journal of Cardiology | volume = 52 | issue = 1 | pages = 14–18 | year = 1983 | month = July | pmid = 6602539 | doi = 10.1016/0002-9149(83)90061-9}}</ref>
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| | ==[[Wellens' syndrome differential diagnosis|Differentiating Wellens' syndrome from other Diseases]]== |
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| | ==[[Wellens' syndrome epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Wellens' syndrome risk factors|Risk Factors]]== |
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| | ==[[Wellens' syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| ===Electrocardiographic Criteria===
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| *Progressive symmetrical deep [[T wave inversion]] in leads V<sub>2</sub> and V<sub>3</sub>
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| *The slope of the [[inverted T waves]] is generally at 60°-90°
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| *There is little or no [[cardiac marker]] elevation
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| *There is discrete or there is no [[ST segment elevation]]
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| *There is no [[loss of precordial R waves]]
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| ==Electrocardiographic Examples==
| | [[Wellens' syndrome history and symptoms| History and Symptoms]] | [[Wellens' syndrome physical examination | Physical Examination]] | [[Wellens' syndrome laboratory findings|Laboratory Findings]] | [[Wellens' syndrome CT|CT]] | [[Wellens' syndrome other imaging findings|Other Imaging Findings]] | [[Wellens' syndrome other diagnostic studies|Other Diagnostic Studies]] |
| [[File:Wellens'_Syndrome.png|center|500px]] | | |
| Shown above is the EKG of a 69-year-old black male with Wellens' sign.
| | ==Treatment== |
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| [[File:Wellens.gif|center|300px|Coronary [[angiogram]] showing tight, critical [[stenosis]] (95%) of the proximal [[Left anterior descending|LAD]] in a patient with Wellens' Warning]] | | [[Wellens' syndrome medical therapy|Medical Therapy]] | [[Wellens' syndrome surgery|Surgery]] | [[Wellens' syndrome primary prevention|Primary Prevention]] | [[Wellens' syndrome secondary prevention|Secondary Prevention]] | [[Wellens' syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Wellens' syndrome future or investigational therapies|Future or Investigational Therapies]] |
| 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.
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| | ==Case Studies== |
| [[File:WellensPain.JPG|center|500px]]
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| Shown above is the EKG of a patient with Wellens' sign during an episode of [[chest pain]].
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| [[File:WellensPainfree.JPG|center|500px]]
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| 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 V<sub>2</sub> and V<sub>3</sub>.
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| ==References==
| | [[Wellens' syndrome case study one|Case#1]] |
| {{reflist|2}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Electrophysiology]] | | [[Category:Disease]] |
| [[Category:Medical signs]]
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