Wellens Syndrome ECG Pattern
Wellens' syndrome: ECG pattern in unstable angina indicating critical proximal LAD stenosis. Two patterns: Type A (biphasic T waves V2-V3) and Type B (deep symmetric T-wave inversions V2-V3). High risk of anterior MI without intervention.
Score interpretation
→ Wellens' Syndrome: All criteria met. Critical proximal LAD stenosis until proven otherwise. DO NOT stress test (risk of precipitating MI). Urgent coronary angiography; admit to CCU; aspirin + P2Y12 inhibitor loading; heparin; cardiology consultation immediately. Typical STEMI management if ST elevates.
→ High suspicion for Wellens' syndrome. Do NOT perform exercise or pharmacological stress testing. Admit; serial ECGs; urgent troponin; cardiology review; plan coronary angiography. Treat as ACS.
→ Does not meet full Wellens' criteria. Consider other causes of T-wave changes (LVH, Takotsubo, myocarditis, hyperkalaemia, LBBB). If clinically concerned: serial ECGs, troponins, cardiology review.
Interpretation bands for the Wellens' Syndrome. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Fridericia Corrected QT Interval (QTcF) · ECG Interpretation
- Modified Sgarbossa's Criteria (Smith Modification) for MI in LBBB · ECG Interpretation
- Brugada Phenocopy Score · ECG Interpretation
- Lead aVR Sign for Left Main / Proximal LAD Occlusion · ECG Interpretation
- de Winter ECG Pattern for Proximal LAD Occlusion · ECG Interpretation
- Isosorbide Mononitrate (Stable Angina) · Nitrate / Stable Angina
- Nicorandil · Stable Angina
- Ranolazine · Refractory Stable Angina
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Pramipexole (Restless Legs Syndrome — Elderly) · Dopamine Agonist (D2/D3 Receptor)
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.