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What is the finding in the following ECG?

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What sign is present here?

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[A] De Winter ECG
[B] Osborn wave
[C] Spiked helmet sign
[D] Wellens’ syndrome

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Wellens’ sign is also called as – Wellens’ syndrome

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Wellens’ syndrome in ECG suggests

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[A] NSTEMI
[B] LMCA disease with Impending Cardiogenic Shock
[C] Critical Proximal LAD stenosis
[D] Myocardial Infarction in presence of LBBB

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Wellens’ sign in ECG

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Best seen in anterior precordial leads – V2-V3

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There are two patterns of T-wave abnormality in Wellens syndrome: now considered as evolving wave forms

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Type A – Biphasic, with initial positivity and terminal negativity (25% of cases)
Type B – Deeply and symmetrically inverted (75% of cases)

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• Originally thought of as two separate types, A and B,
• It is now considered an evolving wave form – initially of biphasic T wave inversions and later becoming symmetrical
• T-wave is – often deep (>2 mm)

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All of the following are common presentations in Wellens syndrome patients EXCEPT

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[A] STEMI
[B] T wave inversions in the anterior precordial leads
[C] History of angina
[D] Normal Cardiac Enzymes

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Which coronary artery is most likely to be involved when we see Wellens Sign in a ECG?

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[A] Right coronary artery
[B] Left main coronary artery
[C] Left anterior descending artery
[D] Circumflex artery

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Clinical, laboratorial and ECG criteria for Wellens’ syndrome is a

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• History of angina
• Minimal or no elevation of cardiac enzymes
• Minimal or no ST-segment elevation (<1 mm)
• No pathological precordial Q waves
• Type 1 – Biphasic T waves in leads V2 and V3
• Type 2 – Deep, symmetrical and inverted T waves in leads V2 and V3

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