- •Acute coronary syndrome may present with various electrocardiographic morphologies.
- •Wellens syndrome is a preinfarction state with distinct electrocardiographic changes in the precordial leads.
- •Wellens syndrome is highly specific for proximal stenosis of the left anterior descending coronary artery.
- •Medical management and cardiac catheterization are usually required for treatment.
- •Nurse practitioners should identify these patients as they present to the emergency department.
Acute coronary syndrome is a leading cause of mortality and morbidity worldwide, requiring emergency care and admission. Wellens syndrome is a preinfarction state that may not have the classic electrocardiographic findings expected with other forms of acute coronary syndrome or the elevated cardiac enzymes. This lack of typical changes in electrocardiography provides a clinical challenge for diagnosis. The ability to promptly identify and treat this time-sensitive state of potential myocardial infarction and death has a significant prognostic value that cannot be overstated.
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- Wellens' syndrome: incidence, characteristics, and long-term clinical outcomes.BMC Cardiovasc Disord. 2022; 22: 176https://doi.org/10.1186/s12872-022-02560-6
- Electrocardiographic manifestations of Wellens' syndrome.Am J Emerg Med. 2002; 20: 638-643https://doi.org/10.1053/ajem.2002.34800
- Wellens Syndrome.StatPearls Publishing, 2022
- Pseudo-Wellens syndrome in a patient with hypertension and left ventricular hypertrophy.Am J Case Rep. 2019; 20: 1231-1234https://doi.org/10.12659/AJCR.916623
- Pharmacodynamic effects and relationships to plasma and oral fluid pharmacokinetics after intravenous cocaine administration.Drug Alcohol Depend. 2016; 163: 116-125https://doi.org/10.1016/j.drugalcdep.2016.04.004
- Pseudo-Wellens’ syndrome secondary to concurrent cannabis and phencyclidine intoxication.BMJ Case Rep. 2018; 2018: bcr-225755https://doi.org/10.1136/bcr-2018-225755
- Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction.Am Heart J. 1982; 103: 730-736https://doi.org/10.1016/0002-8703(82)90480-X
- Wellens’ syndrome presenting as epigastric pain and syncope: an unusual presentation.Cureus. 2020; 12e6877https://doi.org/10.7759/cureus.6877
- Wellen’s syndrome: an ominous EKG pattern.J Emerg Trauma Shock. 2009; 2: 206-208https://doi.org/10.4103/0974-2700.55347
- A particular case of Wellens’ syndrome.Med Hypotheses. 2020; 144110013https://doi.org/10.1016/j.mehy.2020.110013
- Automated pulmonary embolism risk assessment using the wells criteria: validation study.JMIR Form Res. 2022; 6e32230https://doi.org/10.2196/32230
- Rapid ultrasound for shock and hypotension: a clinical update for the advanced practice provider: part 1.Adv Emerg Nurs J. 2020; 42: 270-283
- Use of historical high-sensitivity cardiac troponin T levels to rule out myocardial infarction.Open Heart. 2021; 8e001682https://doi.org/10.1136/openhrt-2021-001682
- T' twist: Wellens syndrome.QJM. 2019; 112: 373-374https://doi.org/10.1093/qjmed/hcy276
- Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery.Am Heart J. 1989; 117: 657-665https://doi.org/10.1016/0002-8703(89)90742-4
- Controversies in Wellens syndrome.QJM. 2019; 112: 827https://doi.org/10.1093/qjmed/hcz129
- Myocardial bridging-an unusual cause of Wellens syndrome: a case report.Medicine (Baltimore). 2020; 99e22491https://doi.org/10.1097/MD.0000000000022491
Giselle Garcia Rivero, DNP, PPCNP-BC, is an assistant professor of clinical at the University of Miami School of Nursing and Health Studies in Miami, FL, and can be contacted att [email protected]
Catherine Nadeau, DNP, FNP-BC, CNE, is an assistant professor and concentration director of the Family Nurse Practitioner Program, University of South Florida in Tampa.
Christina Cardy, DNP, AGACNP-BC, is an assistant professor and concentration director of the Adult Gerontology Acute Care Nurse Practitioner Program, University of South Florida.
Nichole Crenshaw, DNP, AGACNP-BC, AMP -BC, CHSE, is an associate professor of clinical and asssociate dean for undergraduate nursing programs and associate provost for diversity, equity, and inclusion at the University of Miami School of Nursing and Health Studies.
Juan M. Gonzalez, DNP, AGACNP-BC, ENP-C, FNP-BC, CNE, is an associate professor of clinical and director of the Adult Gerontology Acute Care Nurse Practitioner Program, University of Miami School of Nursing and Health Studies.
Published online: February 02, 2023
In compliance with standard ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.
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