Wellens' Syndrome, also known as Coronary T-wave Inversion Syndrome, was identified in the 1980's after a group of patients with unstable angina and characteristic precordial T wave changes on electrocardiogram (ECG) went on to develop large anterior myocardial infarctions. ECG findings are due to critical stenosis in the proximal left anterior descending (LAD) artery. Of patients who present with unstable angina, this ECG pattern is present in 14-18% of cases. Progression from Wellens' Syndrome to anterior myocardial infarction occurs after a mean of 8.5 days and the unique ECG pattern classically presents during chest pain-free periods. On angiography, 100% of patients will have 50% or greater stenosis of the LAD. There are two types of Wellens' Syndrome described, with Type 1 occurring in 76% of cases. There are recognized criteria for Wellens' Syndrome comprised of ECG findings and clinical history.
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