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JAMA Intern Med 2019 Mar 18. Epub 2019 Mar 18.

UC San Diego Medical Center, San Diego, California.

Am J Case Rep 2019 Jan 28;20:117-120. Epub 2019 Jan 28.

Department of Internal Medicine, University of South Florida/HCA West Florida Division Blake Medical Center, Bradenton, FL, USA.

BACKGROUND Acute chest pain is a common presentation in emergency departments worldwide. Ruling out acute coronary syndrome is essential in ensuring patient safety. Workup includes electrocardiogram (ECG) and cardiac biomarkers. Read More

BMJ Case Rep 2018 Dec 19;11(1). Epub 2018 Dec 19.

Internal Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Wellens' syndrome is described as characteristic biphasic or symmetrical T-wave inversion with normal precordial R-wave progression and the absence of Q waves in the right precordial leads. It is seen during chest pain-free interval in a subset of patients with unstable angina. Wellens' syndrome is associated with critical stenosis of proximal left anterior descending (LAD) coronary artery. Read More

QJM 2018 Nov 22. Epub 2018 Nov 22.

Department of Radiology, Al-Wakra hospital, Hamad medical corporation, Doha, Qatar.

N Engl J Med 2018 11;379(18):1780-1781

Herlev-Gentofte Hospital, Copenhagen, Denmark.

J Int Med Res 2018 Nov 3;46(11):4845-4851. Epub 2018 Oct 3.

1 Arrhythmia Unit, Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Wellens' syndrome is characterised by particular changes in electrocardiogram (ECG) precordial lead T-waves accompanied by proximal stenosis of the left anterior descending (LAD) artery. Two cases of electrocardiographic changes associated with Wellens' syndrome are presented here. Case 1, a 55-year-old female, was transferred to the First Affiliated Hospital of Xi'an Jiaotong University with intermittent and laborious angina pectoris. Read More

AACN Adv Crit Care 2018 ;29(3):360-364

Karen M. Marzlin is an APRN, Aultman Hospital; Adjunct Faculty, Malone University; and Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Union-town, OH 44685

Case Rep Cardiol 2018 25;2018:3105653. Epub 2018 Jul 25.

Department of Cardiology, Maimonides Medical Center, New York City, NY, USA.

It is vital to recognize correctly, chest pain of cardiac etiology. Most commonly, it is because of blood supply-demand inequity in the myocardium. However, the phenomenon of myocardial bridging as a cause of cardiac chest pain has come to attention reasonably recently. Read More

BMJ Case Rep 2018 Jun 29;2018. Epub 2018 Jun 29.

Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, USA.

Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. Read More

Heart Rhythm 2018 07;15(7):1114-1115

Cardiovascular Research Institute, Maastricht, The Netherlands. Electronic address:

BMJ Case Rep 2018 Jun 21;2018. Epub 2018 Jun 21.

Internal Medicine, Reading Hospital and Medical Center, West Reading, Pennsylvania, USA.

We describe a case of a middle-aged man who presented to the emergency department with typical anginal chest pains and found to have new, deeply inverted T-waves on ECG consistent with Wellens' syndrome. Similar to the description by Wellens , a critical 99% stenosis of the proximal left anterior descending artery was indeed confirmed by coronary angiography and successfully treated with drug-eluting stent. It is very important that physicians recognise this ECG finding as a harbinger of a serious cardiovascular condition and the necessity for an early invasive cardiac catheterisation. Read More

Clin Pract Cases Emerg Med 2017 Aug 24;1(3):175-178. Epub 2017 May 24.

Duke LifePoint Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, Pennsylvania.

Takotsubo cardiomyopathy, also known as apical ballooning syndrome and stress cardiomyopathy, is a transient systolic and diastolic left ventricular dysfunction with a variety of cardiac wall-motion abnormalities that is increasingly being associated with significant morbidity and mortality. Wellens' syndrome is an electrocardiographic (ECG) pattern in a pain-free patient that is indicative of critical occlusion of the left anterior descending coronary artery requiring immediate cardiac catheterization. The authors report a case of a patient presenting with ECG findings consistent with Wellens' syndrome that was later found to have Takotsubo cardiomyopathy with angiographically normal coronary arteries on cardiac catheterization after a seizure. Read More

Clin Cardiol 2018 07 18;41(7):884. Epub 2018 Jul 18.

Department of Medicine and Pharmacology, University Hospital of Messina, Messina, Italy.

Europace 2019 Feb;21(2):208-218

Cardiovascular Research Institute, Cardiovascular Research Institute, 6229 HX Maastricht, The Netherlands.

Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular pathway, several other new variants of ventricular pre-excitation were reported. Read More

Am J Emerg Med 2018 Jul 7;36(7):1323.e1-1323.e6. Epub 2018 Apr 7.

University Clinic of General and Visceral Surgery, Thoracic Surgery and Proctology, Klinikum Herford, Schwarzenmoorstr. 70, 32049 Herford, Germany. Electronic address:

We present a case of a 54-year-old male patient who was admitted to our Emergency Department (ED) with localized epigastric pain. Inflammation markers, ultrasound, and CT scan were inconsistent with an initial diagnosis of cholecystitis. However, there was additional evidence of cholecystolithiasis. Read More

BMJ Case Rep 2018 Apr 10;2018. Epub 2018 Apr 10.

Hospital do Espirito Santo EPE, Evora, Portugal.

Am J Case Rep 2018 Feb 22;19:199-202. Epub 2018 Feb 22.

Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA.

BACKGROUND Acute coronary syndrome (ACS) is a common and potentially life-threatening condition encountered in emergency departments. Despite its dreaded nature, nearly one-third of ACS present without chest pain and may mislead clinicians. Additionally, Wellens' syndrome is a pre-infarction stage of significant proximal left anterior descending (LAD) artery stenosis, which can lead to extensive anterior wall myocardial infarction without timely intervention. Read More

BMJ Case Rep 2017 Dec 14;2017. Epub 2017 Dec 14.

Department of Cardiology, The Brooklyn Hospital Center-Mount Sinai- Beth Israel Hospital, New York, New York, USA.

Wellens' syndrome represents critical occlusion of the proximal left anterior descending coronary artery. Electrocardiographic changes similar to Wellens' wave are not exceptional to acute coronary occlusion and can also be seen in cardiac and non-cardiac conditions, such as left ventricular hypertrophy, persistent juvenile T wave, bundle branch blocks, cerebral haemorrhage, pulmonary oedema, pulmonary embolism, pheochromocytoma, Takotsubo syndrome, digitalis and cocaine-induced coronary vasospasm. Cocaine-induced pseudo-Wellens' syndrome should be considered as one of the differentials, since cocaine is used frequently by young adults and can cause left anterior descending coronary vasospasm mimicking Wellens' syndrome. Read More

Ann Transl Med 2017 Oct;5(20):401

Department of Cardiology, Saint Joseph's Regional Medical Center, Paterson, NJ, USA.

The course of epicardial coronary arteries into a muscular tunnel under a bridge of myocardium is known as myocardial bridging (MB). This could be a benign anomaly, nevertheless, it could have a great impact on the quality of life in the setting of severe anginal symptoms. The clinical presentation and diagnosis could be challenging in those patients. Read More

Cleve Clin J Med 2017 Aug;84(8):590-591

Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.

Rev Clin Esp 2017 Nov 8;217(8):491. Epub 2017 Aug 8.

Servicio de Cardiología, Complejo Hospitalario Universitario de Granada, Granada, España.

Ci Ji Yi Xue Za Zhi 2017 Apr-Jun;29(2):127-128

Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.

Hellenic J Cardiol 2017 Nov - Dec;58(6):453-455. Epub 2017 Jul 8.

Department of Cardiology, Elpis General Hospital of Athens, Athens, Greece. Electronic address:

Medicine (Baltimore) 2017 Jun;96(24):e7152

aDepartment of Medicine, Brookdale University Hospital and Medical Center bDepartment of Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, NY.

Background: Wellens syndrome is a pattern of electrocardiographic (ECG) changes in the context of unstable angina characterized with deep inverted T-waves or biphasic T-waves in the precordial leads. These specific ECG changes are highly suggestive of stenosis in the left anterior descending artery (LAD), which can result in acute myocardial infarction, left ventricular dysfunction, or death. Human immunodeficiency virus (HIV) infection is known as an independent risk factor for the cardiovascular disease. Read More

Int J Cardiovasc Imaging 2017 Oct 27;33(10):1541-1549. Epub 2017 May 27.

Department of Cardiology, Faculty of Medicine, Clinical Hospital Centre Zemun, University of Belgrade, Vukova 9, 11070, Belgrade, Serbia.

Some patients with unstable angina and critical stenosis of the left anterior descending coronary artery (LAD) present with Wellens syndrome (WS), i.e., inverted or biphasic T-waves in the anterior precordial leads. Read More

Heart Rhythm 2017 10 4;14(10):1427-1433. Epub 2017 May 4.

Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium.

Background: Patients with drug-induced Brugada syndrome (BS) are considered at a lower risk than those with a spontaneous type I pattern. Nevertheless, they can present arrhythmic events.

Objective: The purpose of this study was to investigate their clinical characteristics, long-term prognosis and risk factors. Read More

Eur Heart J 2017 Jun;38(22):1756-1763

Heart Rhythm Management Centre, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.

Aims: Risk stratification in Brugada Syndrome (BS) remains challenging. Arrhythmic events can occur life-long and studies with long follow-ups are sparse. The aim of our study was to investigate long-term prognosis and risk stratification of BS patients. Read More

Emerg Med J 2017 Apr;34(4):264-266

Institution Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.

Wellens' syndrome consists of a history suggestive of an acute coronary syndrome and biphasic or deeply inverted T waves in ECG leads V2-V3. A shortcut review was carried out to establish whether this ECG pattern identifies patients with a critical left anterior descending artery stenosis. Six relevant papers were found. Read More

Cardiology 2017;137(2):100-103. Epub 2017 Feb 15.

Cardiology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.

Wellens' syndrome is characterized by an electrocardiographic pattern of T-wave changes associated with a critical stenosis of the left anterior descending artery (LAD), which progresses to an extensive anterior myocardial infarction in the majority of cases. For this reason, its recognition and early treatment are extremely important. We report 2 cases of Wellens' syndrome: an 83-year-old male presenting with ill-characterized chest pain, biphasic T waves in V1-V3 during an asymptomatic period, negative cardiac biomarkers, and a 64% stenosis in LAD with a fractional flow reserve of 0. Read More

Herzschrittmacherther Elektrophysiol 2017 Mar 9;28(1):57-59. Epub 2017 Feb 9.

Emergency Department, Klinikum Herford, Schwarzenmoorstr. 70, 32049, Herford, Germany.

Diagnosing acute myocardial infarction (AMI) in left bundle branch block (LBBB) is challenging. Modified Sgarbossa criteria are known to help detect AMI in LBBB. This is a report about an electrocardiogram (ECG) with Wellens' signs in combination with a pre-existing LBBB. Read More

Am J Emerg Med 2017 Jun 24;35(6):938.e5-938.e7. Epub 2016 Dec 24.

Stony Brook University Hospital, Department of Emergency Medicine, 101 Nicolls Road, Stony Brook, NY 11794, United States; Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States. Electronic address:

We illustrate the case a patient with left bundle branch block (LBBB) and electrocardiogram (ECG) changes consistent with those described in Wellens' syndrome. The characteristic ECG findings of Wellens' syndrome identify patients who have a particularly high rate of important coronary events in the near future, however these findings have previously been described only in the setting of normal conduction. A review of Wellens' syndrome, its criteria and pathophysiology, and its proposed appearance in the setting of LBBB is presented. Read More

Cardiology 2017;137(1):9-13. Epub 2016 Dec 13.

Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.

We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for acute coronary syndrome, Wellens syndrome in particular, given the elevated troponin levels, lack of ST segment changes, and characteristic T-wave findings. The diagnosis was confirmed with angiography that showed a critical left anterior descending (LAD) artery occlusion. Read More

Am J Emerg Med 2017 Apr 3;35(4):664.e1-664.e2. Epub 2016 Nov 3.

Department of Cardiology, Aerospace Center Hospital, 15 Yuquan road, Beijing 100049, People's Republic of China.

Negative T waves in electrocardiography have been widely studied. We presents a case of Wellens' syndrome which is a pattern of global inverted T waves with QT prolongation on ECG due to transient proximal LAD occlusion and pointed out other differential diagnosis. Read More

Am J Emerg Med 2017 Jan 5;35(1):175-176. Epub 2016 Oct 5.

Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Rd, Haidian District, Beijing 100049, PR China.

Med Klin Intensivmed Notfmed 2017 Nov 18;112(8):703-707. Epub 2016 Oct 18.

Zentrale Notaufnahme, Klinikum Herford, Schwarzenmoorstr. 70, 32049, Herford, Deutschland.

The ECG is a very important diagnostic tool if an acute coronary syndrome is suspected. It should be performed immediately when medical staff contacts the patient. If an ST elevation myocardial infarction (STEMI) is diagnosed, immediate reperfusion of the occluded vessel should be the primary goal. Read More

J Community Hosp Intern Med Perspect 2016 7;6(4):32011. Epub 2016 Sep 7.

Department of Internal Medicine, Easton Hospital, Easton, PA, USA.

Wellens' syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens' syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI. Read More

Eur J Intern Med 2017 Mar 20;38:e2-e3. Epub 2016 Aug 20.

Department of Internal Medicine and Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.

A 64year old man presented with atypical chest pain of 6h duration. Physical examination showed tachycardia and an irregularly irregular pulse. Initial EKG showed atrial fibrillation with rapid ventricular rate. Read More

J Am Coll Cardiol 2016 08;68(6):614-623

Heart Rhythm Management Center, Cardiovascular Division, UZ Brussel-Vrije Universiteit Brussel, Brussels, Belgium.

Background: A proband of Brugada syndrome (BrS) is the first patient diagnosed in a family. There are no data regarding this specific, high-risk population.

Objectives: This study sought to investigate the Brugada probands diagnosed from 1986 through the next 28 years. Read More

Emerg Med J 2017 Feb 29;34(2):119-123. Epub 2016 Jul 29.

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.

Background: Reperfusion after coronary occlusion (myocardial infarction, MI), as in Wellens' syndrome, is often represented on ECG as T-wave inversion in the leads overlying the affected myocardial wall(s). As an extension of this logic, reperfusion of the posterior wall should manifest on right precordial leads (which are opposite the posterior wall) as enlarged T-waves.

Objective: We sought to determine whether T-wave amplitude (TWa) in leads V2 and V3 after reperfusion in posterior MI (PMI) is greater than in patients without PMI. Read More

Clin Case Rep 2016 Jun 26;4(6):558-60. Epub 2016 Apr 26.

Department of internal cardiology Guangzhou Overseas Chinese Hospital Guangzhou Guangdong 510632 China.

The case is a 52-year-old male admitted to cardiology department with chest tightness. Admission ECG showed nontypical T-wave changes in V2-V4 leads in pain peroids, and increasing severe narrowing of proximal LAD. Cardiac enzymes were abnormal. Read More

Postgrad Med J 2017 Jan 5;93(1095):53. Epub 2016 Jul 5.

World J Emerg Med 2016 ;7(2):153-6

Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Intern Emerg Med 2017 03 8;12(2):267-268. Epub 2016 Jun 8.

Cardiology Department, Hospital Clínic, University of Barcelona, C/Villarroel, 170, 08036, Barcelona, Spain.

Turk J Emerg Med 2015 Dec 11;15(4):179-81. Epub 2016 Mar 11.

Dr. Siyami Ersek Chest & Cardiovascular Surgery Training & Research Hospital, Cardiology Clinic, Istanbul, Turkey.

Wellens' Syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending (LAD) artery stenosis. Diagnostic criteria of Wellens' Syndrome are history of chest pain, little or no cardiac enzyme elevation, little or no ST-segment elevation, no loss of precordial R waves, no pathologic precordial Q waves and typical T-wave changes. Urgent cardiac catheterization is vital to prevent myocardial necrosis. Read More

Acta Inform Med 2016 Feb 2;24(1):72-3. Epub 2016 Feb 2.

Gulhane Military Medical Academy, Department of Emergency Medicine, Ankara, Turkey.

Introduction: Wellens Syndrome (WS) is a condition characterized by typical changes in ECG, which are biphasic T-wave inversions (less common) or symmetric and deeply inverted T waves (including 75%) in lead V2-V3 chest derivations. WS is considered important because it has not only diagnostic value but also prognostic value.

Case Report: A 52-year-old male patient without cardiovascular disease or risk factors was admitted to the emergency department (ED) suffering with chest pain and syncope, just after having been involved in a discussion at work. Read More

MMW Fortschr Med 2016 Mar;158(5):46

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Can J Cardiol 2016 12 29;32(12):1578.e3-1578.e5. Epub 2015 Dec 29.

Department of Cardiology, University Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Europace 2017 Jan 17;19(1):81-87. Epub 2016 Feb 17.

Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.

Aim: The aim of our study is to compare two approaches of implantable cardiac defibrillator (ICD) implantation, conventional (supra/subpectoral) and subcostal in young adults in terms of procedural complications and adverse events encountered during follow-up.

Methods And Results: From January 2007 to December 2013, all patients under the age of 50 years who received an ICD in our centre were included in this study. Patient's hospital records were analysed for procedural complications and adverse events during follow-up until December 2014. Read More

Int J Cardiol 2016 Apr 3;209:22-3. Epub 2016 Feb 3.

Department of Cardiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai 519000, PR China. Electronic address: