Wellens' syndrome type B ECG pattern in a pain-free patient who was previously having typical anginal chest pain is characterised by:

• A Tall peaked T waves in V1-V4 with ST elevation
• B Biphasic T waves (initial positive then negative deflection) in V2-V3
• C Deeply symmetrically inverted T waves in V2-V3 ✓
• D ST depression >2 mm in V4-V6 with upright T waves

Explanation

Wellens' syndrome indicates critical proximal LAD stenosis in a pain-free patient who had recent ischaemic chest pain. Type A (less common, ~25%) shows biphasic T waves (initial positive, then negative deflection) in V2-V3. Type B (more common, ~75%) shows deeply symmetrically inverted T waves in V2-V3 with no or minimal ST elevation. These patterns reflect reperfusion of myocardium still at risk; stress testing is contraindicated. Prompt angiography is required as anterior STEMI may be imminent.

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

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Written and medically reviewed by the StethoPrep medical team.