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Clin Pract Cases Emerg Med 2020 May 2;4(2):137-141. Epub 2020 Mar 2.

Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia.

This is a novel case report of a 44-year-old woman who presented to the emergency department with epigastric pain wrapping around to her back. She had no risk factors for cardiac disease, but her initial electrocardiogram (ECG) showed a Wellens syndrome pattern and she was taken urgently to the catheterization lab. After a negative catheterization, she underwent cardiac magnetic resonance imaging, which was positive for Takotsubo cardiomyopathy (TC). Read More

CMAJ 2020 04;192(14):E384

Health services researcher, University of Waterloo, Waterloo, Ont.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620918552

Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.

With an estimated contribution of up to 6% of all acute coronary events, young adults are experiencing an escalating burden and mortality attributable to coronary artery disease (CAD) worldwide. Wellens syndrome, a preinfarction clinical entity with distinctive electrocardiographic (ECG) features and high propensity for extensive anterior wall infarctions, affects about 15% of unstable angina subpopulation. We report challenges and lessons learnt from the first ever documented case of Wellens syndrome in Tanzania. Read More

J Int Med Res 2020 May;48(5):300060520911495

Department of Geriatric Cardiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.

A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and any of the four cardiac chambers, the large vessels, or other vascular structures. Wellens syndrome is an ST-segment elevation myocardial infarction equivalent. Although both Wellens syndrome and CAFs have been reported in the literature, they have rarely been reported in the same patient. Read More

Cureus 2020 Feb 4;12(2):e6877. Epub 2020 Feb 4.

Internal Medicine, Brookdale University Hospital Medical Center, New York, USA.

Wellens' syndrome, also regarded as left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending artery (LAD) stenosis. It is characterized by deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads in a patient with unstable angina. Patients typically present with symptoms consistent with acute coronary syndrome. Read More

J Med Case Rep 2019 Dec 30;13(1):387. Epub 2019 Dec 30.

Atlanta Veterans Health Care System, Decatur, GA, USA.

Background: Chest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies.

Case Presentation: A 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. Read More

J Electrocardiol 2020 Jan - Feb;58:61-62. Epub 2019 Nov 21.

Cardiovascular Research Institute, Maastricht, the Netherlands.

We present two cases with unexpected long sinus arrest resulting in syncope. There were no signs or symptoms of either sick sinus syndrome or increased vagal tone before the occurrence of pauses in these patients. The fact that these patients remained asymptomatic for quite long shows striking resemblance to paroxysmal sub-AV nodal block. Read More

Case Rep Emerg Med 2019 16;2019:1582030. Epub 2019 Sep 16.

Department of Internal Medicine, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA.

Wellens syndrome is an electrocardiographic (ECG) pattern involving waves in precordial leads that was first described in 1982 among a group of patients presenting with unstable angina suggestive of critical stenosis of the proximal left anterior descending (LAD) coronary. It is crucial for emergency physicians and internists to be able to recognize these patterns, as they occur in the symptom-free periods and represent a pre-infarction state that needs early intervention. Type A, which is characterized by biphasic waves, mainly in V2 and V3, poses a significant challenge to recognize the pattern, and failure to do so can lead to devastating outcome. Read More

Monaldi Arch Chest Dis 2019 Sep 30;89(3). Epub 2019 Sep 30.

Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia; Cardio-Thoracic Department, ASST Spedali Civili, Brescia.

Wellens' syndrome is a pattern of electrocardiographic T-wave changes seen in the precordial leads in patients with unstable angina. Two different patterns have been described. Type A presents with biphasic T-waves in V2-V3 and type B presents with symmetrical deep T-wave inversions in V2-V3. Read More

Am J Med Case Rep 2019 6;7(11):297-300. Epub 2019 Sep 6.

Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203.

Patients with human immunodeficiency virus (HIV) are at higher risk for coronary artery disease, due to accelerated atherosclerosis resulting from chronic inflammation, the prevalence of cardiovascular risk factors and the side effects of highly active antiretroviral therapy (HAART). The Wellens' pattern is an electrocardiographic (ECG) finding that represents critical proximal left anterior descending (LAD) coronary artery stenosis that, that when is not promptly treated, can lead to extensive anterior wall myocardial infarction and death. Very few cases of Wellens' syndrome in HIV positive patients have been reported. Read More

Ann Noninvasive Electrocardiol 2020 03 9;25(2):e12693. Epub 2019 Sep 9.

Centro Cardiovascular BV, Bella Vista, Argentina.

Wellens' syndrome refers to electrocardiographic (ECG) abnormalities in the precordial T-wave segment, which are associated with critical stenosis of the proximal left anterior descending (LAD) coronary artery. According to medical literature, this ECG abnormality is of paramount importance because this syndrome represents a preinfarction stage of coronary artery disease; however, same ECG pattern can also be seen in other conditions. Coronary fistula occurs due to anomalous communications between a coronary artery and a cardiac chamber or other vessel in the vicinity of the heart. Read More

Am J Cardiol 2019 10 27;124(8):1305-1314. Epub 2019 Jul 27.

Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.

Early initiation of reperfusion therapy remains the cornerstone of successful management for ST-elevation myocardial infarction (STEMI). Rapid restoration of coronary blood flow relies on prompt recognition of the typical ST-segment elevation on a 12-lead electrocardiogram (ECG)-a surrogate for coronary occlusion or critical stenosis-allowing timely activation of the STEMI protocol cascade, with a major positive impact in mortality and clinical outcomes. However, atypical, very high risk ECG patterns-known as "STEMI equivalents"-are present in 10% to 25% of patients with ongoing myocardial ischemia in need of urgent primary percutaneous coronary intervention. Read More

Am J Case Rep 2019 Aug 20;20:1231-1234. Epub 2019 Aug 20.

Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

BACKGROUND Wellens syndrome is a form of unstable angina that warrants a timely intervention to prevent extensive myocardial infarction. A few conditions can lead to electrocardiogram (EKG) changes mimicking Wellens syndrome. CASE REPORT A 61-year-old African American man with no significant medical history was admitted for chest pain and new biphasic EKG changes in leads V2 through V6 concerning for Wellens' syndrome. Read More

Adv J Emerg Med 2019 9;3(3):e30. Epub 2019 Jun 9.

Division of Cardiology, University of Catania, Catania, Italy.

Introduction: We describe a patient without a history of cardiovascular diseases as an example of Wellens' syndrome (WS).

Case Report: A 65-year-old man presented to emergency department due to intermittent chest pain. Physical examination and chest x-ray were unremarkable. Read More

J Cardiovasc Electrophysiol 2019 Oct 20;30(10):2170-2180. Epub 2019 Aug 20.

Post-Graduation, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.

The famous quotation of Winston Churchill, made in his radio broadcast of 1939 regarding Russia's next move, specifically "A riddle wrapped up in a mystery, inside an enigma," perfectly fits the current understanding of unusual accessory atrioventricular pathways, including the variants producing ventricular pre-excitation. It was many decades after their original descriptions that we came better to begin to understand most of their structure-function relationships. Their mysterious pathophysiology was sometimes unveiled after invasive treatments, such as surgical ablation of the atrioventricular conduction axis instead of the accessory pathway itself. Read More

Am J Med Sci 2020 01 19;359(1):e1-e2. Epub 2019 Jul 19.

Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia.

Cardiovasc J Afr 2019 Jul/Aug 23;30(4):e1-e3. Epub 2019 May 24.

Department of Cardiology, General Hospital of Chinese PLA, Beijing, China.

Wellens' syndrome is a relatively common clinical entity; however, it is often missed, especially in young patients. Without prompt diagnosis and aggressive intervention, patients with Wellens' syndrome may rapidly go on to develop extensive anterior wall myocardial infarction and possibly sudden death. In this case report, we present a 33-year-old male patient with atypical chest pain, and discuss the significance of a prompt recognition of Wellens' syndrome. Read More

QJM 2019 Oct;112(10):825-826

Consultant in Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA.

QJM 2019 Oct;112(10):827

Department of Radiology and Clinical Imaging, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.

JAMA Intern Med 2019 May;179(5):704-706

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 2019 May;112(5):373-374

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