Lightning Learning: Wellens Syndrome

Lightning Learning: Wellens Syndrome


Wellens syndrome describes a pattern of deeply inverted or biphasic T-waves in V2 and V3 → this is highly specific for a critical stenosis of the Left Anterior Descending Artery (LAD).


  • Maybe pain free at time when initial ECG is taken

  • May have normally or minimally elevated cardiac enzymes

  • At extremely high risk for extensive anterior wall MI within the next few days to week


  • Analgesia as required

  • Serial ECGs

  • Require urgent cardiology review


There are TWO ECG pattern types…

Type A: Biphasic with initial positivity and terminal negativity (25% of cases)

Type B: Deeply and symmetrically inverted (75% of cases)


  1. The ECG in Acute MI (S. Smith, A. Zvosec, S. Sharkey, T. Henry)
  2. Wellens syndrome ECG library (LITFL)
  3. 12-lead ST segment monitoring in Wellens' syndrome (Dr Smith’s ECG Blog)
Lightning Learning: Hard Pill to Swallow?

Lightning Learning: Hard Pill to Swallow?