Advanced ECG interpretation: Wellens' Warning!



  • The ECG demonstrates symmetic T wave inversions in leads V1-V3 with normal appeaing ST segments. This pattern is consistent with Wellen's warning



  • The original article was published in 1982 by de Zwaan et al and reported on 145 patients admitted for "impending MI" of which 26 had a T wave pattern associated with significant LAD stenosisA further study of 1260 AMI patients included 180 patients with these ECG characteristics and all had 50% to complete obstruction of the proximal LAD


  • The two patterns of T waves described are:

1. Deep symmetric T wave inversions in leads V1-V4

2. Biphasic T waves in V2 and V3 (inital upslope followed by downslope)


  • Patients presenting with chest pain and Wellen's warning should be considered for early (though not necessarily emergent) cardiac catheterization, avoiding stress testing


  • Our patient went for PCI the following day and had uncomplicated stenting of a 95% mid LAD lesion