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Wellens Pattern: Same ECG Curve, Different Pathways
Giovanni Arghittu1, Manuela Iseppi2, Davide Giovannini2
1Division of Cardiology, Ospedale Santa Chiara, Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Insights
Prompt recognition of Wellens syndrome, an ECG pattern indicating critical left anterior descending artery stenosis, is crucial. Timely intervention improves outcomes for patients with this often-missed condition.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Wellens syndrome is an ECG pattern of T-wave inversions in V2-V3.
- It signifies critical proximal left anterior descending artery stenosis.
- Often presents asymptomatically with normal troponin levels, leading to under-recognition.
Introduction:
Wellens syndrome refers to a characteristic electrocardiographic pattern, marked by inverted or biphasic T waves in leads V2 and V3, associated with a critical proximal stenosis of the left anterior descending artery. Patients with Wellens syndrome typically present asymptomatically and with normal or slightly elevated troponin levels. This condition is frequently under-recognized, leading to delays in diagnosis and treatment.
Case Summary:
We report 4 clinical cases, 3 women and 1 man, with a mean age of 64 years and no prior cardiac history. All patients initially presented with a clinical picture of unstable angina or non-ST-segment elevation myocardial infarction, with a characteristic Wellens pattern on electrocardiogram. In 2 patients, the pattern was promptly recognized, however in the other 2 cases, the diagnosis was initially missed, resulting in delayed intervention.
Conclusions:
Our case series show how promptly recognition and timely action can lead to better prognosis in terms of myocardial injury and left ventricular ejection fraction.
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