Wellens Syndrome Clinical Presentation

Updated: Jan 25, 2018
  • Author: Benjamin B Mattingly, MD; Chief Editor: Erik D Schraga, MD  more...
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Wellens syndrome represents stenosis of the proximal left anterior descending coronary artery (LAD), and patients typically present with symptoms or complaints consistent with coronary artery disease (CAD). Generally, the history is most consistent with unstable angina. Angina can have varying presentations, but the classic presentation includes the following complaints:

  • Chest pain described as pressure, tightness, or heaviness

  • Pain that is typically induced by activity and relieved by rest

  • Radiation of pain to the jaw, shoulder, or neck

  • May experience multiple associated symptoms, including (but not limited to) diaphoresis, nausea, vomiting, and fatigue

Elderly, diabetic, and female patients are more likely to present with atypical symptoms.


Physical Examination

Physical examination does not provide any indicators that would give the examiner strong grounds for suspecting Wellens syndrome specifically. However, the results of the patient’s examination may show evidence of ongoing ischemic injury (eg, congestive heart failure [CHF]).

In addition, most of the electrocardiographic (ECG) changes are recognized when the patient is pain-free, which again underscores the importance of a repeat pain-free ECG in the emergency department.