Ominus T waves-Wellens Syndrome!

ECG diagnosis in patient presenting with critical LAD stenosis is utmost importance.
T wave changes in acute ischemia is well described.

WELLENS SYNDROME
A. Definition EKG pattern of T waves in the precordial leads that are associated with a critical stenosis of the proximal left anterior descending coronary artery

B. Simplified criteria for Wellens Syndrome

• Prior history of chest pain
• Little or no cardiac enzyme elevation.
• No pathologic precordial Q waves.
• Little or no ST-segment elevation.
• No loss of precordial R waves.
• Biphasic T waves in leads V2 and V3 (Type 1) or symmetric, often deeply inverted T waves in leads V2 and V3 (Type 2).
• NOTE: these EKG changes usually occur during a pain-free interval when other evidence of ischemia or unstable angina may be absent.
• C. What is important about Wellens Syndrome?
• It is highly specific for left anterior descending coronary artery lesions.
• These patients are at risk for an extensive anterior wall myocardial infarction and/or sudden death.
• Early cardiac catheterization with subsequent angioplasty or CABG is now recommended for these patients.
• D. Pitfalls
• Diagnosing the biphasic T-wave pattern as "nonspecific" EKG changes, which they are not.
• Diagnosing the EKG changes as nontransmural or subendocardial ischemia/infarction and treating them with conservative therapy.
• In AE s with chest pain centers, placing these patients in the "nonspecific" EKG protocol and doing an exercise stress test on them. Exercise stress tests are contraindicated in the presence of suspected left main lesions.

Reference: Wellens Syndrome, Annals of Emergency Medicine, March 1999, Vol.33, No. 3, pp347-351.
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