Wellen's Syndrome

Question 1

Wellen’s syndrome is a change to the ______ of the ECG 2/2 ischemia.

A. PRI
B. QRS complex
C. ST segment
D. T-wave morphology

Answer 1

D. T-wave morphology

Question 2

______ Wellen’s Syndrome occurs with biphasic T-waves.

A. Type A
B. Type B

Answer 2

A. Type A

Question 3

______ Wellen’s Syndrome occurs with T-wave inversion.

A. Type A
B. Type B

Answer 3

B. Type B

Question 4

(Type A/Type B) Wellen’s pattern is the most common presentation.

Answer 4

Type B - 75% of cases

Question 5

T-wave changes are most often found in what leads with Wellen’s syndrome?

A. II, III, aVF
B. V2-V3
B. V4-V6

Answer 5

B. V2-V3

Question 6

T/F: Wellen Syndrome may be diagnosed in the case of STEMI.

Answer 6

False. Dx criteria for Wellen’s requires there be isoelectric or minimally elevated (STE less than 1 mm) ST segments

Question 7

In Wellen’s syndrome, R-wave progression occurs normally int he precordial (V1-V6) leads.

Answer 7

True

Question 8

T/F: Wellen’s syndrome must be diagnosed by the presence of T-wave changes in a pain free patient.

Answer 8

True

Question 9

What pulmonary condition may produce T-wave changes in the 12-lead ECG? This is also a DDx for Wellen’s.

Answer 9

Pulmonary embolism.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267566/

Question 10

What is the finding on ECG indicative of pulmonary embolism?

Answer 10

S1Q3T3

Lead I: S-wave
Lead III: Q-wave
Lead III: T-wave inversion

Question 11

S1Q3T3 is present in _____% of PE patients.

Answer 11

15-25%. Therefore, PE versus Type B Wellen’s may not always be ruled out.

Question 12

Specifically, the presence of S1Q3T3 is a sign of what cardiac abnormality?

A. cor pulmonale
B. mitral stenosis
C. pulmonary embolism

Answer 12

A. cor pulmonale - A sign of right ventricular strain. When blood backs up into the right ventricle (which pumps blood to the pulmonary circulation), the RV becomes overloaded by blood. The Frank-Starling mechanism indicates that the RV should attempt to increase contractility to overcome this new pressure head of stagnant blood, but the RV STRAINS against it.

Incorrect:
B. mitral stenosis -

C. pulmonary embolism - Though PE may produce S1Q3T3 on ECG, embolism is an abnormality of blood in the lungs, NOT the heart. And no, this is is not splitting hairs.

Question 13

Explain HOW right ventricular strain produces ECG changes.

Answer 13

By definition, strain is a “…repolarisation abnormality due to right ventricular hypertrophy or dilatation.”

delve into further when not so tired

Question 14

Why is treatment/transport/evaluation of the pain-free Wellen’s patient important?

Answer 14

Wellen’s syndrome with T-wave changes indicate the patient is at risk for an anterior wall MI in the next 2-3 weeks.