The daily educational pearl – Wellen’s syndrome

Wellen’s Syndrome

= pattern of ECG changes that indicates proximal LAD lesion; also known as the “widow maker”


1. Characteristic T wave changes – deep Twave inversion in V2,V3 (type1)

OR biphasic T waves in V2-V3 (type2)

Both types of T wave changes can occur in V1,V5,V6 as well
2. History of angina or chest pain, but pain-free when ECG done
3. Normal to slightly elevated troponin
4. No evidence of STEMI
5. No pathological Q waves
6. No loss of R waves across the pre cordial leads (poor R wave progression)

These findings can normalise when the patients have chest pain!

These patients need urgent cardiology admission coronary angiography followed by PCI or CABG.
Stress testing can precipitate AMI and fatal arrhythmias and is contraindicated.

With thanks to Yusuf.

Images from Roberts J, Electrocardiograms You Need to Know: Wellens’ Syndrome, Emergency Medicine News, August 2009 – Volume 31 – Issue 8 – pp 12-14