Today, I spent several hours tossing and turning during the day for a patient with anterior wall T-wave changes, and in the evening I unintentionally came across a new concept, at least for the first time for me, who does not like to learn, this new term is Wellens’ syndrome, so I searched for information and would like to share it with you here. Wellens’ syndrome, also known as left anterior descending T-wave syndrome, was first reported by Wellens in 1982 and is characterized by characteristic T-wave changes and dynamic evolution in patients with unstable angina in the chest leads (mainly in leads V2-3) after an episode of chest pain. The pathology is based on severe stenosis (>50%) of the proximal left anterior descending branch of the coronary artery, resulting in severe ischemia of the anterior left ventricular wall myocardium. This concept has the following implications: (1) such characteristic T-wave changes occur only in some patients with unstable angina; (2) when the ECG is normal or without ischemic changes during angina, but after the termination of the symptomatic episode, symmetrical deep inversion or bidirectional T-wave in the chest leads appears instead; (3) the ECG changes can last from several hours to several weeks, and such characteristic T-wave changes can be repeated; (4) coronary angiography ( CAG) most patients have severe proximal stenosis of the left anterior descending coronary artery (>75%). Wellens syndrome is not uncommon clinically, with a reported incidence of 10%-15% in the United States, and similar statistics are not available in China. It occurs after the relief of chest pain in patients with unstable angina, and myocardial damage markers are normal or mildly increased. Echocardiography may show reduced left ventricular anterior wall motion, CAG shows severe proximal stenosis of the left anterior descending coronary artery, and the longer the duration of T-wave inversion, the more severe the lesion tends to become. Wellens syndrome ECG has the following characteristics: (1) characteristic T-wave changes mainly appear in the anterior thoracic leads, mainly in leads V2-3, sometimes they can be extended to leads V1-6, and in a few cases there are also characteristic changes in leads II, III and aVF; (2) no abnormal Q-wave or R-wave amplitude decreases or disappears; (3) no ST-segment shift or only mild elevation (<0.1mv); (4) after angina relief The dynamic evolution of symmetrical deep inversion or bidirectional T-wave, which gradually turns upright and lasts from a few hours to several weeks; ⑤ the above characteristic changes of T-wave can be repeated after another angina attack. Sobnosky et al. also divided Wellens syndrome into two types according to the morphology of T-wave changes: type 1: anterior chest leads Type 1: deep symmetrical inversion of the T wave, accounting for about 75% of cases; Type 2: bidirectional T wave changes, accounting for 25% of cases. The exact mechanism of Wellens syndrome is not well understood, but may be related to the following factors: ① Myocardial inhibition and myocardial hibernation: Most scholars believe that when the myocardial ischemia in the anterior wall of the left ventricle is severe, it can cause characteristic changes in T waves, and the evolution of T waves reflects the recovery of myocardial function in the ischemic area of inhibition or hibernation. As myocardial ischemia improves, the degree of T-wave inversion gradually becomes shallower, ventricular wall motion disorders are improved, and cardiac function is gradually restored; ② It has been observed that in some patients there can be a mild increase in myocardial injury markers, indicating myocardial injury and necrosis, which are shallow (shallower than subendocardial infarction) and are not sufficient to cause dynamic QRS waves and ST segments like ST-segment elevation infarction. It is a special type of myocardial infarction because it can only cause the characteristic evolution of T waves. It is very important to raise the awareness of T-wave changes in the electrocardiogram of Wellens syndrome and to provide targeted treatment, otherwise it will have serious consequences. (1) the presence of Wellens syndrome indicates severe stenosis in the proximal left anterior descending coronary artery; (2) this UA is a high-risk angina and is likely to progress to acute extensive anterior wall myocardial infarction without further treatment; (3) early coronary angioplasty or coronary artery bypass grafting, for which Wellens syndrome is a strong indication, can benefit patients.