Wellens Syndrome ECG/EKG, Types, Symptoms, Criteria, Management, Treatment

 Content:

• What is Wellens Syndrome? 
• Wellens Syndrome ECG/EKG 
• Wellens Syndrome Types
• Wellens Syndrome Symptoms
• Wellens Syndrome Criteria
• Wellens Syndrome Management
• Wellens Syndrome Treatment

What is Wellens Syndrome?

 Wellens Syndrome is a condition that indicates a critical narrowing of the proximal left anterior descending (LAD) artery. It is considered a pre-infarction state, meaning that patients with this syndrome are at high risk of developing a large anterior myocardial infarction (MI) if not treated promptly.

 

Wellens Syndrome ECG/EKG

Type A (Biphasic T Waves):

• Pattern: Initial positive deflection followed by a negative deflection.
• Leads: Most noticeable in leads V2 and V3.
• Significance: Indicates ischemia of the proximal LAD artery.

Type B (Deeply Inverted T Waves):

• Pattern: Deeply inverted, symmetric, and tall T waves.
• Leads: Commonly seen in V2 and V3, but can be present in other precordial leads.
• Significance: Suggests more severe ischemia or near-total occlusion of the LAD.

No Significant ST Elevation or Q Waves:

• ST Segments: Should be normal or only slightly depressed.
• Q Waves: Absent (no evidence of infarction yet).
• Significance: Distinguishes Wellens from STEMI, where ST elevation and Q waves are common.

Normal or Mildly Elevated Cardiac Biomarkers:

• Troponin Levels: Can be normal or slightly elevated.
• Significance: Different from STEMI, where troponin levels are usually more significantly elevated.
• No Symptoms at Time of ECG:

Key Point: The ECG is often done when the patient is pain-free or at rest, after chest pain has subsided.

Wellens Syndrome Types

Wellens Syndrome has two types, based on the ECG findings:

• Type A (Biphasic T Waves):

1. Pattern: T waves are biphasic, with an initial positive deflection followed by a negative deflection.
2. Leads: Most commonly seen in V2 and V3.
3. Significance: Indicates proximal LAD artery ischemia.

• Type B (Deeply Inverted T Waves):

1. Pattern: T waves are deeply inverted, symmetric, and tall.
2. Leads: Seen mainly in V2 and V3.
3. Significance: Suggests severe ischemia or near-total occlusion of the LAD artery.

Both types represent a pre-infarction state and require urgent evaluation and intervention to prevent a large myocardial infarction.

Wellens Syndrome Symptoms

1. Intermittent chest pain, often at rest, which resolves before ECG is taken.
2. Pressure-like or tightness in the chest, usually brief but can be severe.
3. Pain-free during ECG, despite previous episodes of chest discomfort.
4. History of angina or recurring chest pain with minimal exertion.
5. Fatigue or shortness of breath, especially during pain episodes.
6. High risk of a large anterior myocardial infarction if untreated.

Wellens Syndrome Criteria

Wellens Syndrome is diagnosed based on specific ECG criteria, including characteristic T wave changes in leads V2-V3, which may be biphasic or deeply inverted. There is no significant ST elevation, helping to differentiate it from STEMI, and no pathological Q waves, indicating that infarction has not yet occurred. 

Troponin levels are typically normal or only mildly elevated, despite clear ischemic changes on ECG. Patients usually have a history of chest pain that resolves before the ECG is taken, and R wave progression remains preserved in the precordial leads. If left untreated, Wellens Syndrome carries a high risk of a large anterior myocardial infarction, requiring urgent coronary angiography and intervention.

Wellens Syndrome Management

Management of Wellens Syndrome requires urgent intervention due to the high risk of a large anterior myocardial infarction. Patients should be immediately admitted to a cardiac care unit (CCU) for close monitoring. The cornerstone of treatment is urgent coronary angiography to assess the extent of proximal LAD stenosis, followed by angioplasty (PCI) or coronary artery bypass grafting (CABG) if necessary. 

Medications like aspirin (to prevent clot formation), heparin (to reduce further clot risk), beta-blockers (to lower myocardial oxygen demand), and statins (to reduce cholesterol) are prescribed. Stress testing should be avoided, as it can trigger a myocardial infarction. Continuous monitoring for arrhythmias and signs of worsening ischemia is essential. Long-term management includes lifestyle modifications, antiplatelet therapy, beta-blockers, and statins to prevent further events and improve overall cardiovascular health. Early intervention is key to preventing a fatal myocardial infarction.

Wellens Syndrome Treatment

Treatment of Wellens Syndrome focuses on preventing a large anterior myocardial infarction through urgent intervention. Immediate hospital admission to a cardiac care unit (CCU) is essential for close monitoring. The most critical step is urgent coronary angiography, which helps confirm proximal LAD artery stenosis, followed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) if needed. 

Medical therapy includes aspirin and heparin to prevent clot formation, beta-blockers to reduce myocardial oxygen demand, and statins for cholesterol management. Stress testing is contraindicated, as it can provoke a heart attack. Continuous ECG monitoring is necessary to detect any worsening ischemia or arrhythmias. Long-term treatment includes lifestyle modifications, antiplatelet therapy, beta-blockers, and statins to prevent future cardiovascular events. Early intervention is crucial to prevent a potentially fatal myocardial infarction.