Wellens Syndrome

Wellens syndrome comes in two electrocardiographic varieties – biphasic T waves (up then down, type A) or deeply inverted and symmetric T waves in the anterior precordial leads V1-V3 (type B). The syndrome requires these ECG findings in a patient that is chest pain free. If the patient develops chest pain and the T waves “pseudonormalize” (i.e., become upright), complete occlusion is suggested. Wellens syndrome represents a special category of high-risk acute coronary syndrome that should have an urgent catheterization planned with the cardiologist. Patients in whom Wellens syndrome is a consideration should not get a stress test given the risk of a large anterior myocardial infarction.



  1. Zwaan D, Biir FWHM, Wellens HJJ. Characteristic electrocardiogric pattern indicating a critical stenosis high in left anteior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4):730-736.