Overview
What is the historical background of Wellens syndrome?
What are the diagnostic criteria for Wellens syndrome?
What is the pathophysiology of Wellens syndrome?
What are the risk factors for Wellens syndrome?
What is the prognosis of Wellens syndrome?
Presentation
What is the clinical presentation of Wellens syndrome?
What are the physical exam findings in Wellens syndrome?
DDX
What are the diagnostic considerations in Wellens syndrome?
Which conditions should be considered in the diagnosis of Wellens syndrome?
What are the differential diagnoses for Wellens Syndrome?
Workup
Which lab studies are indicated in the workup of Wellens syndrome?
What is the role of imaging studies in the workup of Wellens syndrome?
What is the role of electrocardiography in the workup of Wellens syndrome?
What is the role of angiography in the workup of Wellens syndrome?
What is the role of stress testing in the workup of Wellens syndrome?
Treatment
What are the approach considerations in the treatment of Wellens syndrome?
When is prehospital care indicated for Wellens syndrome?
What prehospital care is indicated for Wellens syndrome?
What is the initial emergency department treatment of unstable angina in Wellens syndrome?
What emergency care is indicated in the treatment of Wellens syndrome?
What inpatient care is indicated in the treatment of Wellens syndrome?
Medications
What is the goal of drug therapy in the treatment of Wellens syndrome?
Which medications in the drug class Opioid Analgesics are used in the treatment of Wellens Syndrome?
Which medications in the drug class Nitrates, Angina are used in the treatment of Wellens Syndrome?
Which medications in the drug class Salicylates are used in the treatment of Wellens Syndrome?
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This ECG represents a patient who came in to the emergency department with 8/10 chest pain. The patient had old right bundle-branch block (RBBB) and left ventricular hypertrophy (LVH), and this compared similarly to his previous ECGs.
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Classic Wellens syndrome T-wave changes. ECG was repeated on a patient who came in to the emergency department with 8/10 chest pain after becoming pain free secondary to medications. Notice the deep T waves in V3-V5 and slight biphasic T wave in V6 in this chest pain– free ECG. The patient had negative cardiac enzyme levels and later had a stent placed in the proximal left anterior descending (LAD) artery.
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A 57-year-old with 4/10 pressurelike chest pain. Improvement with treatment by EMS. The patient had this ECG on arrival. Notice perhaps the beginning of a small biphasic T wave in V2.
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Pain-free ECG of a 57-year-old patient who presented with 4/10 pressurelike chest pain. Notice after the patient was treated with medications and pain subsided, the ECG shows T-wave inversion in V2 and biphasic T waves in V3-V5. This more closely resembles the less common presentation of Wellens syndrome with a biphasic T-wave pattern. This patient had a cardiac catheterization that showed a subtotal occlusion of the proximal left anterior descending (LAD) artery, which was stented, and the patient did well.
