“Wellen’s syndrome: An ominous EKG pattern” – Links To The Article And An Excerpt – And GXT Is Strongly Contraindicated

The article, Wellen’s syndrome: An ominous EKG pattern [Link is to the full text HTML], is an important article for all clinicians. It should be read in its entirety. For that reason, I have included only the abstract and the conclusion [Note to myself: Reread the whole article]:


Wellen’s syndrome is a characteristic T-wave on an electrocardiogram during a pain-free period in a patient with intermittent chest pain. This finding suggests a high-degree stenosis of the proximal left anterior descending (LAD) coronary artery that will soon result in an acute anterior wall myocardial infarction (MI) if the patient is not urgently catheterized and the occlusion opened. This case report discusses a young male patient with no known cardiac disease with an EKG that demonstrates the classic Wellen’s T-waves. He was urgently taken to cardiac catheterization and his 95% proximal LAD stenosis was reduced via drug-eluding stent. Through knowledge of Wellen’s T-waves, more anterior wall MIs can be prevented.


Wellen’s syndrome presents with characteristic EKG findings that all Emergency Physicians need to recognize due to the significant percentage of patients who will develop anterior wall myocardial infarctions if aggressive intervention is not undertaken. Patients in whom Wellen’s syndrome is suspected should undergo urgent cardiac catheterization. Stress testing is contraindicated as increasing cardiac demand with a highly stenosed left anterior descending may lead to myocardial infarction. Patients who do not have known heart disease or multiple common cardiac risk factors such as our patient can be spared from an acute myocardial infarction by quick recognition of these classic T-wave changes.


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