Wellens Syndrome

• proximal LAD lesion
• Biphasic (type A) or deep monophasic (type B) TWI commonly on V2/3, rarely all precordial leads
• Reperfusion T waves (open artery or collaterals)

Make sure: Clinical 1, ECG 5, labs 1

• NO chest pain by the time ECG is done (this is a reperfusion T wave)
• Morphology: compare this Wellens to this PE TWI
• R wave is preserved (because only small amount of myocardium is infarcted), if it is not preserved, it could be an old MI and not Wellens
• QTc is prolonged (benign TW inversion has QTc of 400-420ms
• Lead III T wave is upright (consider PE if III TW is inverted)
• No Tachycardia (consider other cause eg. PE if tachycardic)
• Small or no elevation of cardiac markers (small myocardium infarcted)

Differentials:

• Acute R heart strain (like PE/Severe Pneumonia/Severe Asthma)
• Other causes of TW inversion