Home / ECG Case Quiz # 4 : Answers

ECG Case Quiz # 4 : Answers


The initial ECG suggested perhaps the beginning of a small biphasic T wave in V2.

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The repeat ECG performed after the pain had resolved shows T-wave inversion in V2 and biphasic T waves in V3-V5.

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This more closely resembles the less common, Type B presentation of Wellens syndrome with a biphasic T-wave pattern. This patient had a cardiac catheterization that showed a subtotal occlusion of the proximal left anterior descending (LAD) artery, which was stented, and the patient did well.

Wellens syndrome (aka Wellens Warning) is a characteristic pre-cordial T-wave morphology on an ECG during a pain-free period in a patient with intermittent chest pain.These findings suggests a critical stenosis of the proximal left anterior descending (LAD) coronary artery. This pre-infarction syndrome will often result in an acute anterior wall myocardial infarction.


Wellens Syndrome criteria include:

During chest pain, the ECG is normal or with mild ST elevation, depression or with terminal negative deflection of the T waves in V1 and V2
Characteristic T-wave changes
History of anginal chest pain
Normal or minimally elevated cardiac enzyme levels
ECG without Q waves, without significant ST-segment elevation, and with normal precordial R-wave progression
Deeply inverted or biphasic T-waves in V2 and V3, possible V1, V4, V5 and/or V6 when pain free


Type A Wellens syndrome is characterized by Deep T-wave inversions in the mid-precordial leads (V2-4)

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Type B Wellens Syndrome reveals biphasic T-waves in V1-3


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