Wellens' syndrome represents a critical ECG finding in an otherwise pain-free patient after a brief episode of chest pain. Which ECG pattern in Wellens' Type A (biphasic T-waves) indicates critical LAD stenosis?

• A Deep symmetrical T-wave inversions in V2–V3
• B ST elevation in V1–V4 with new LBBB
• C Biphasic T-waves in V2–V3 with initial positivity then negativity ✓
• D Tall peaked T-waves in precordial leads

Explanation

Wellens' syndrome is an ECG pattern seen in the pain-free interval after unstable angina, indicating critical proximal LAD stenosis with impending anterior MI. Type A (Pattern I) features biphasic T-waves in V2–V3 with initial positivity then terminal negativity; Type B (Pattern II) features deep symmetrical T-wave inversions in V2–V3. Both indicate reperfusion of the proximal LAD and are associated with high risk of massive anterior STEMI. Stress testing is absolutely contraindicated; urgent coronary angiography and revascularization are required.

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

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