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在左束支传导阻滞的情况下，Wellens综合征可能提示存在高度左前降支狭窄。

Wellens' syndrome can indicate high-grade LAD stenosis in case of left bundle branch block.

作者信息

Grautoff Steffen

机构信息

Emergency Department, Klinikum Herford, Schwarzenmoorstr. 70, 32049, Herford, Germany.

出版信息

Herzschrittmacherther Elektrophysiol. 2017 Mar;28(1):57-59. doi: 10.1007/s00399-017-0489-z. Epub 2017 Feb 9.

DOI:10.1007/s00399-017-0489-z
PMID:28185080
Abstract

Diagnosing acute myocardial infarction (AMI) in left bundle branch block (LBBB) is challenging. Modified Sgarbossa criteria are known to help detect AMI in LBBB. This is a report about an electrocardiogram (ECG) with Wellens' signs in combination with a pre-existing LBBB. The ECG of a patient with fluctuating chest pain showed very subtle and one day later more obvious Wellens'signs. A left anterior descending artery (LAD) stenosis was diagnosed and successfully treated. Wellens' syndrome can be diagnosed in a case of LBBB and help detect a high-grade LAD stenosis even if modified Sgarbossa criteria are not met.

摘要

诊断左束支传导阻滞（LBBB）中的急性心肌梗死（AMI）具有挑战性。已知改良的Sgarbossa标准有助于检测LBBB中的AMI。这是一篇关于伴有Wellens征并合并既往LBBB的心电图（ECG）报告。一名胸痛症状波动的患者的心电图显示非常细微，一天后Wellens征更加明显。诊断为左前降支（LAD）狭窄并成功治疗。即使不符合改良的Sgarbossa标准，在LBBB病例中也可诊断出Wellens综合征，并有助于检测高度LAD狭窄。

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引用本文的文献

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A Rare Presentation of a Rare Entity: Wellens Syndrome with Subtle Terminal Wave Changes.一种罕见疾病的罕见表现：伴有细微终末波改变的Wellens综合征。
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Atypical Presentation of Acute Coronary Syndrome and Importance of Wellens' Syndrome.急性冠状动脉综合征的非典型表现及Wellens综合征的重要性。

本文引用的文献

1
Wellens syndrome with a pacemaker rhythm.
J Emerg Med. 2013 Jan;44(1):e123-4. doi: 10.1016/j.jemermed.2012.02.083. Epub 2012 Oct 15.
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Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule.应用改良 Sgarbossa 规则中 ST 段抬高与 S 波比值诊断左束支传导阻滞伴 ST 段抬高型心肌梗死。
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Electrocardiographic manifestations of Wellens' syndrome.Wellens综合征的心电图表现。
Am J Emerg Med. 2002 Nov;20(7):638-43. doi: 10.1053/ajem.2002.34800.
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Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators.左束支传导阻滞时进展期急性心肌梗死的心电图诊断。GUSTO-1（冠状动脉闭塞时链激酶和组织型纤溶酶原激活剂的全球应用）研究人员。
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Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction.因即将发生心肌梗死而入院的患者，其特征性心电图模式提示左前降支冠状动脉高位严重狭窄。
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