Dynamic T-wave inversions in the setting of left bundle branch block

We illustrate the case a patient with left bundle branch block (LBBB) and electrocardiogram (ECG) changes consistent with those described in Wellens' syndrome. The characteristic ECG findings of Wellens' syndrome identify patients who have a particularly high rate of important coronary events in the near future, however these findings have previously been described only in the setting of normal conduction. A review of Wellens' syndrome, its criteria and pathophysiology, and its proposed appearance in the setting of LBBB is presented.