Wellens syndrom: Think about that

• Main Author: Stefanović Ivana
• Format: Article
• Language: English
• Published: Serbian Medical Society, Department of Emergency Medicine, Belgrade 2016-01-01
• Series: ABC: časopis urgentne medicine
• Subjects: angina pectoris; wellens syndrome; lad stenosis; differential diagnosis
• Online Access: https://scindeks-clanci.ceon.rs/data/pdf/1451-1053/2016/1451-10531602025S.pdf
• ISSN: 1451-1053; 2560-3922

Introduction: In 1982. H.J.J. Wellens and his group first described characteristic ECG pattern of T waves in the precordial leads, in patient with unstable angina, that were associated with a critical stenosis of the proximal left anterior descedending coronary artery. Aim: Introduction of emergency physician with this syndrome, because the ECG pattern sometimes the only sign of serious myocardial damage, in the abcence of other indicators of ischemia. Materials and methods: Searching available Medline database and Pubmed, by entering keywords. RESULTS: Wellness and colleagues first reported clinical and ECG criteria, the disease later named, Wellens syndrome. Knowledge of this syndrome, allows the identification of patients who are at high risk of critical stenosis of the LAD, and subsequent infarctions of the anterior wall. Before he explained the importance of the full recognition of this EKG pattern, Wellens was a note of that as much as 75% of these patients developed anterior wall infarction, regardless of the applied medical therapy. There are two variants of ECG changes in this syndrome. First, rarer, consists in a biphasic T wave in V2 and V3, and other, more frequent, presented deeper symmetrical inverted T wave in V2 and V3, often in V1 and V4, and sometimes in V5 and V6. Simplified criteria for Wellens syndrome are previous history of chest pain, low cardiac enzymes, the absence of precordial R and pathological Q-wave, small or slight ST elevation. Wellens criteria are specific to the disease of LAD. Many processes can cause changes in the T wave, and the differential diagnosis should be considered in the Q wave and nonQ infarction, myocarditis, pulmonary embolism, stroke, WPW syndrome, left ventricular hypertrophy, etc. Conclusion: Emergency medicine physicians should think about this syndrome and how to avoid underestimating the severity of lesions, and errors in the proper hospitalization and treatment of these patients.