Medical Case Details:
67-year-old male, asymptomatic. Screening ECG shows Wellens type B. Now, what should be the next step? Urgent Angiography or just medical management?Discussions
Dr. Zulfiqar Ahmed
Diabetologist
The distinct ECG patterns of Wellens’ syndrome, indicating myocardial ischemic disease caused by critical proximal left anterior descending (LAD) stenosis, could be overlooked due to the absence of the typical ST segment elevation of ST-segment elevation myocardial infarction.
There are two ECG patterns in Wellens’ syndrome: Type A is characterized by deeply symmetrical T-wave inversions in leads V2 and V3, often including leads V1 and V4 and occasionally leads V5 and V6; type B is characterized by biphasic T-waves in leads V2 and V3. The positive predictive value of Wellens’ sign is approximately 86%. The differential diagnosis in patients with similar ECG changes includes myopericarditis, Wolf–Parkinson–White syndrome, digitalis effect, and pulmonary embolic disease
In clinical practice, stress testing might be performed due to lack of typical ST segment elevation in Wellens’ syndrome to obtain more evidence of cardiac ischemia. However, increasing cardiac demand during stress testing may result in acute myocardial infraction, and even fatal dysrhythmia and death Therefore, it is essential to consider the coronary angiogram as the initial diagnostic modality instead of other conservative examinations in patients with ECG patterns, indicating a possibility of Wellens’ syndrome.
Diabetologist
The distinct ECG patterns of Wellens’ syndrome, indicating myocardial ischemic disease caused by critical proximal left anterior descending (LAD) stenosis, could be overlooked due to the absence of the typical ST segment elevation of ST-segment elevation myocardial infarction.
There are two ECG patterns in Wellens’ syndrome: Type A is characterized by deeply symmetrical T-wave inversions in leads V2 and V3, often including leads V1 and V4 and occasionally leads V5 and V6; type B is characterized by biphasic T-waves in leads V2 and V3. The positive predictive value of Wellens’ sign is approximately 86%. The differential diagnosis in patients with similar ECG changes includes myopericarditis, Wolf–Parkinson–White syndrome, digitalis effect, and pulmonary embolic disease
In clinical practice, stress testing might be performed due to lack of typical ST segment elevation in Wellens’ syndrome to obtain more evidence of cardiac ischemia. However, increasing cardiac demand during stress testing may result in acute myocardial infraction, and even fatal dysrhythmia and death Therefore, it is essential to consider the coronary angiogram as the initial diagnostic modality instead of other conservative examinations in patients with ECG patterns, indicating a possibility of Wellens’ syndrome.
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23.May, 05:01am
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