23-10: Wellens Waves

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

Biphasic (“type A”) or deeply inverted (“type B”) T waves in V₂-V₄.
Isoelectric or minimal elevation of the ST segment (< 1 mm).
Absence of precordial Q waves.
R-wave progression is preserved.

Pearls

These characteristic patterns of T-wave changes are closely associated with a subacute critical LAD artery stenosis.
The changes are classically apparent on ECG after resolution of chest pain.
These changes are often not associated with cardiac biomarker elevations.
In the absence of ongoing pain or serial ECG changes, these patients can often be treated with urgent, rather than emergent, coronary intervention.

FIGURE 23.10A

Wellens Waves. Wellens waves are present in the anterior leads and are indicative of a high-grade LAD lesion. (ECG contributors: Clifford L. Freeman, MD, and Nicole S. McCoin, MD.)

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FIGURE 23.10B

Wellens type A, demonstrating biphasic T waves in the mid-precordial leads. These findings in the setting of suspected acute coronary syndrome strongly suggest an underlying high-grade LAD lesion.