Wellens syndrome

Wellens syndrome:

The pearl: T-wave changes in leads V2–V3 (biphasic or deeply inverted, symmetric) in a patient who's now pain-free with normal or near-normal troponin. This is a critical LAD stenosis until proven otherwise.

The trap: because the patient looks fine and enzymes are unimpressive, it's tempting to risk-stratify with a stress test. Don't. Stress testing can precipitate a large anterior MI. These patients need urgent angiography.

How to spot it fast:

Preserved R-wave progression (rules out prior anterior infarct)

No significant ST elevation, no pathologic Q waves

Pattern present when pain-free; T waves can pseudo-normalize during active chest pain (a diagnostic clue in itself)