Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction

Naming and classifying old and new ECG phenomena

“…1,2 These ECG patterns, named after Wellens and de Winter, respectively, occasionally replace the classic ECG manifestations of ST-elevation myocardial infarction (STEMI). Initially described in 1982 3 and 2008, 4 respectively, both correspond to proximal severe disease of the left anterior descending artery, with rapid recognition and intervention being required to ensure revascularization.…”

“…3,4 The differences between the two patterns may reflect the timing of ECG relative to total occlusion of the vessel, spontaneous reperfusion of the vessel, initiation of the ischemic process or reso lution of the ischemic process. Recognizing the two patterns can help physicians to make correct and timely medical decisions, so as to rescue as much myocardium as possible.…”

Wellens’ Syndrome in an Elderly Patient with Dementia

“…1 Reconsideration of her initial ECG revealed a less common variant of Wellens' Syndrome: biphasic T waves in leads V1-V3. 2,3 The more common pattern is deep, symmetrically inverted T waves in leads V2 and V3 (or other precordial leads), often during a chest pain- Fig. 1 Initial ECG with biphasic T waves in leads V1-V3, a less common variant of Wellens' Syndrome free interval.…”

“…1 Initial ECG with biphasic T waves in leads V1-V3, a less common variant of Wellens' Syndrome free interval. 2,4,5 Wellens' syndrome has been found in up to 14% of patients with unstable angina whose angiograms showed a mean LAD stenosis of 85%. 6 Recognition of Wellens' syndrome is important, because these subtle ECG patterns are associated with impending extensive anterior wall MI in up to 75% of patients.…”

“…6 Recognition of Wellens' syndrome is important, because these subtle ECG patterns are associated with impending extensive anterior wall MI in up to 75% of patients. 2,4 Conflicts of interest: All authors contributed to the preparation of this manuscript. We have no conflicts of interest to disclose or any financial disclosures to report.…”