Pseudo-Wellens' Syndrome

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I recently saw post-op patient sent down to the ED (no ICU at this hospital), who had biphasic T wave changes in her anterior leads and had complained of chest pain, which was relieved with anginine. The patient was discussed with cardiology and transferred to coronary care. In this patient there was no doubt that this was Wellen’s Syndrome. Beware when diagnosis this disorder, which is linked to a critical LAD stenosis and has a poor outcome for the majority of patients if no action is taken.

When is Wellen’s not Wellens’  i.e., What are the mimics? Pseudo-Wellens’s a similar pattern to Wellens’, resulting from abnormal T waves, due to left ventricular hypertrophy(LVH).

 

So if there is LVH we cannot diagnose Wellens’  on ECG. The patient may however still have ischaemia, so beware. One more thing that is different in Pseudo-Wellens’, is that the changes are more lateral i.e.., V3-V6, whereas in true Wellens’ they are at V2-V3. Have a look below:

 

 

 

 

 

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.

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