Wellens' syndrome on ECG indicates critical stenosis of the proximal left anterior descending artery. Which ECG pattern is characteristic of Type B (more common) Wellens' syndrome?
- A Biphasic T-waves in V2–V3 (terminal positivity), pain-free interval
- B ST elevation >2 mm in V1–V4 with reciprocal changes in II, III, aVF
- C Deep symmetric T-wave inversions in V2–V3 (and often V1–V4), pain-free interval ✓
- D Pathological Q waves in V1–V4 with poor R-wave progression
Correct answer: C. Deep symmetric T-wave inversions in V2–V3 (and often V1–V4), pain-free interval
Explanation
Wellens' syndrome has two patterns: Type A features biphasic T-waves (negative-positive) in V2–V3 (accounting for ~25% of cases), while Type B features deep, symmetric T-wave inversions in V2–V3 extending to V1–V4 (~75% of cases, more common). Both patterns occur during the pain-free period after an episode of chest pain and indicate severe proximal LAD stenosis requiring urgent angiography — stress testing is contraindicated as it can precipitate anterior MI. These ECG changes represent reperfusion injury/stunning of the anterior wall.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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