[NOTE] ECG - Wellens syndrome－G‧N‧M

A 49 y/o man had chest tightness and follow by pain for one day,

radiated to left shoulder accompanied cold sweating.

Here is the 1st ECG at ED：

What is your idea and next step？

I will script this ECG as Sinus rhythm, VPC, 84 bpm, ST elevation and biphasic T wave at V2~3.

Wellens syndrome is come into my mind.

However, the patient insist on waiting for the cardiac enzymes data, refuse for revascularization or admission

despite CV specialist's advice.

The following 2nd ECG：

And the cardiac enzymes data came out without suprise：

Thus, he was sent to cath. room.

The cath finding：

LAD： P 99%, DB1 70% stenosis

Lcx： D 90%, OM 90% stenosis

這不是太難的心電圖，但卻要很小心的是，有些時候，可能 ST 段或是 Troponin-I 不一定會高；

但這心電圖卻強烈暗示著近期的左前降枝梗塞，前壁心肌梗塞。

老師教的，cold sweating 是一個很警覺的症狀，因為那是裝不出來的！

所以一但有這症狀，心電圖一定要放大仔細看！

Wellens syndrome：

Wellen's syndrome is reffered to as LAD cornary T-wave syndrome

(or even anterior MI reperfusion syndrome)

Syndrome criteria includ the following：

● Characteristic T-waves changes

● History of anginal chest pain

● Normally or minimally elevated cardiac enzyme levels

● ECG without Q waves, without significant ST segment elevation, and with normal precordial R waves progression.

● Wellens syndrome is a pattern of inverted or biphasic T waves in V2-3 (in patients presenting with ischemic chest pain) that is highly specific for critical stenosis of the left anterior descending artery.

● Patient may be pain free by the time ECG is taken and have normally or minimally elevated cardiac enzymes; however, they are at extremely high risk for extensive anterior wall MI within the next 2-3 weeks.

There are two patterns of T-wave abnormality in Wellen's syndrome：

● Type A Wellen's T-waves are deeply and symmetrically inverted.

● Type B Wellen's T-waves are biphasic, with the initial deflection positive and the terminal deflection negative.

Wellen's type A：