A 60-year-old man presents with acute chest pain. ECG shows deep, symmetrical T-wave inversion in leads V2-V4 with minimal ST elevation of less than 1mm. Troponin is borderline. Which term best describes this pattern?

• A De Winter T waves
• B Benign early repolarization
• C Left ventricular hypertrophy with strain
• D Wellens syndrome ✓

Explanation

Wellens syndrome is characterized by deep symmetrical T-wave inversion (or biphasic T waves) in leads V2-V4, representing a critical proximal left anterior descending artery stenosis. It occurs during a pain-free interval and indicates high-risk unstable angina requiring urgent angiography and intervention. De Winter T waves show upsloping ST depression with tall T waves and are an STEMI equivalent. LVH with strain shows asymmetric ST-T changes. Benign early repolarization shows notched J points and concave-up ST elevation.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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