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\begin{document}

\title{Title : Separating Inverted U wave syndrome described by Dr. Gerson from
Wellen's syndrome is meaning less as both describing exactly the same
condition}



\author[1]{Mohammad Reza Movahed}%
\affil[1]{Affiliation not available}%


\vspace{-1em}



  
  \date{June 14, 2024}


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Author: Mohammad Reza Movahed, MD, PhD, FACP, FCCP, FACC,
FSCAI\textsuperscript{1,2,3}

University of Arizona Tucson\textsuperscript{1} University of Arizona
Phoenix\textsuperscript{2}

Correspondent:

M Reza Movahed, MD, PhD, FACP, FACC, FSCAI, FCCP

Clinical Professor of Medicine, University of Arizona, Tucson

Clinical Professor of Medicine, University of Arizona, Phoenix

1501 No Campbell Aven

Tucson, AZ 85724

Tel: 949 400 0091

Email: rmova@aol.com

Conflict of interest: None

Keywords: Acute coronary syndrome; Wellen EKG; Inverted U waves;
anterior myocardial infarction; proximal left anterior ascending artery;
acute myocardial infarction

With great interest, I read the paper about challenges in
Electrocardiography entitled ``Inverted U Waves---Red Flags in
Electrocardiogram'' by Shu et al. (1)~ Initially, the authors correctly
described Wellen's syndrome (2) that was seen in their patient's first
~EKG consistent with proximal LAD disease. However, they described the
second EKG as an Inverted U wave syndrome with reference to Dr. Gerson
who described first time this condition. Unfortunately, the authors did
not review EKGs that were published under inverted U waves in the
literature including original Dr. Gerson's papers. By reviewing
published EKGs under inverted U wave including the referenced Dr. Gerson
publication, it can clearly be seen that the so-called inverted U wave
is actually a terminally inverted T wave similar to Wellen's description
of Wellen's EKG as inverted U wave. (3,4) Figures below are showing the
original EKG illustration described by Dr. Gerson as inverted U wave
syndrome.~ The first EKG is from the paper describing an inverted U wave
after exercise and the second EKG is from the subsequent paper
describing an inverted U wave at rest as a warning sign for proximal LAD
lesions:\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

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\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

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\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

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As it can clearly be seen, they described the terminally inverted T wave
(exactly the same description by Wellen et al.) as inverted U wave
syndrome. This fact that unfortunately the same syndrome is described as
two separate conditions is extensively discussed by Movahed (5,6) but
the authors failed to reference these papers. Another EKG published as
an inverted U wave by Savori et al. et al (7) describing inverted U wave
syndrome is exactly the same as Wellen's EKG:

Dr. Gerson's group should get the initial credit for describing and
publishing this phenomenon before Dr. Wellen.~ However, not mentioning
Dr. Gerson in their publications, it created confusion in describing
this EKG pattern in the medical community. ~Since original descriptions
of this EKG abnormality by Dr. Gerson and Wellen, this pattern has been
confirmed and recognized numerous times by many clinicians but only
described by some authors as Wellens' syndrome~(8-11)~~while others only
mentioned it as inverted U waves~(12-14)~~but never both until we
published about this fact and this confusion (5,6).

References:

\begin{enumerate}
\tightlist
\item
  Shu H, Liao BJ, Peng D. Inverted U Waves-Red Flags in
  Electrocardiograms. JAMA Intern Med. 2023 Jul 31. doi:
  10.1001/jamainternmed.2023.1743
\item
  de Zwaan C, B\selectlanguage{ngerman}är FW, Janssen JH, Cheriex EC, Dassen WR, Brugada P, Penn
  OC, Wellens HJ. 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
  Mar;117(3):657-65
\item
  Gerson MC, Phillips JF, Morris SN, McHenry PL. Exercise-induced U-wave
  inversion as a marker of stenosis of the left anterior descending
  coronary artery. Circulation. 1979 Nov;60(5):1014-20.
\item
  Gerson, M.C. and P.L. McHenry, \emph{Resting U wave inversion as a
  marker of stenosis of the left anterior descending coronary artery.}Am
  J Med, 1980. \textbf{69} (4): p. 545-50.
\item
  Movahed MR. Wellens' syndrome or inverted U-waves? Clin Cardiol. 2008
  Mar;31(3):133-4
\item
  Lee Y, Habibzadeh MR, Movahed MR. Wellens Syndrome or Inverted U
  Waves: A Serious Clinical Condition Needing Immediate Attention
  Regardless of Symptoms. Am J Med. 2021 Nov;134(11):1365-1367
\item
  Sovari AA, Farokhi F, Kocheril AG. Inverted U wave, a specific
  electrocardiographic sign of cardiac ischemia. Am J Emerg Med. 2007
  Feb;25(2):235-7
\item
  Kardesoglu, E., et al., \emph{Wellens' syndrome: a case report.} J Int
  Med Res, 2003. \textbf{31} (6): p. 585-90.
\item
  Rhinehardt, J., et al., \emph{Electrocardiographic manifestations of
  Wellens' syndrome.} Am J Emerg Med, 2002. \textbf{20} (7): p. 638-43.
\item
  Tandy, T.K., D.P. Bottomy, and J.G. Lewis, \emph{Wellens'
  syndrome.}Ann Emerg Med, 1999. \textbf{33} (3): p. 347-51.
\item
  Conover, M., \emph{Wellens' syndrome: identification of critical
  proximal left anterior descending stenosis.} Crit Care Nurse,
  1990.\textbf{10} (2): p. 30-6.
\item
  Miwa, K., et al., \emph{Exercise-induced negative U waves in
  precordial leads as a marker of viable myocardium in patients with
  recent anterior myocardial infarction.} Int J Cardiol,
  2000.\textbf{73} (2): p. 149-56.
\item
  15. Tamura, A., et al., \emph{Significance of negative U waves in the
  precordial leads during anterior wall acute myocardial infarction.} Am
  J Cardiol, 1997. \textbf{79} (7): p. 897-900.
\item
  16. Gregory, S.A., et al., \emph{Inverted U waves.} Am J Med,
  2006.\textbf{119} (9): p. 746-7..
\end{enumerate}

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