Wellens' syndrome

Wellens' syndrome is a pattern of ECG changes associated with critical stenosis of the left anterior descending coronary artery, which can progress to an extensive anterior wall myocardial infarction if not recognized and treated appropriately. It is named after Hein J.J. Wellens, a Dutch cardiologist who first described the syndrome in 1982.

Clinical Presentation

Patients with Wellens' syndrome typically present with a history of angina, often with a recent increase in frequency or severity. The pain is usually described as a heavy or squeezing sensation in the chest, often radiating to the left arm or jaw. On examination, the patient may appear anxious and sweaty, but is often comfortable at rest.

Diagnosis

The diagnosis of Wellens' syndrome is made on the basis of the characteristic ECG changes, which include deep, symmetric T wave inversions in the anterior leads (V1-V4). These changes are typically present during pain-free periods and may be transient, reverting to normal between episodes of pain. Other diagnostic criteria include the absence of significant ST segment elevation and the absence of pathologic Q waves.

Treatment

The treatment of Wellens' syndrome involves urgent coronary angiography to identify the site of the critical stenosis, followed by revascularization, usually by means of percutaneous coronary intervention (PCI). Medical management with antiplatelet therapy, beta blockers, and statins is also important.

Prognosis

The prognosis of Wellens' syndrome is poor if left untreated, with a high risk of progression to extensive anterior wall myocardial infarction. However, with early recognition and appropriate treatment, the prognosis can be significantly improved.

See Also

• Electrocardiography
• Left anterior descending artery
• Anterior wall myocardial infarction
• T wave
• ST segment
• Pathologic Q wave
• Percutaneous coronary intervention
• Antiplatelet therapy
• Beta blockers
• Statins

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