Also known as LAD coronary T-wave syndrome, is a specific pattern observed on ECG that indicates a critical blockage in the left anterior descending (LAD) coronary artery.
It is crucial to emphasize that Wellens syndrome is a time-sensitive condition requiring prompt recognition and management to prevent a major adverse cardiac event.
Diagnostic criteria of Wellens syndrome include:
a recent chest pain that has resolved,
negative or minimally elevated troponins,
abnormal ECG pattern which include:
biphasic or deeply inverted symmetric T waves in precordial leads, mainly in V2 and V3,
absence of pathologic Q waves,
isoelectric or minimally elevated ST segment, and
normal R wave progression.
Note that, the ECG may appear normal during chest pain period.
Treatment of Wellens syndrome include:
Immediate cardiac consultation Wellens syndrome is considered a high-risk finding that requires urgent evaluation by a cardiologist. Cardiac consultation is crucial to confirm the diagnosis and determine appropriate management.
Avoid stress testing Stressing the heart through exercise or pharmacological stress tests is contraindicated in patients with Wellens syndrome, as it can potentially lead to a complete blockage of the LAD artery, resulting in a heart attack.
Coronary angiography and revascularization as needed The gold standard for diagnosing LAD stenosis is coronary angiography. This invasive procedure allows visualization of the coronary arteries to identify and assess the severity of the blockage. Once LAD stenosis is confirmed, revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be performed to restore blood flow to the affected area of the heart.
Medications In addition to revascularization procedures, appropriate medical management includes antiplatelets, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to manage blood pressure and optimize heart function.