A 68-year-old man with hypertension presented with a 3-day history of intermittent chest pain. On arrival, his vital signs were stable, and his symptom subsided. Laboratory findings were unremarkable without elevated cardiac biomarkers. An electrocardiogram showed deeply T wave inversions in leads V1-V5, which were suggestive of Wellens syndrome (Picture A, arrows). A transthoracic echocardiogram showed no regional wall motion abnormalities with a normal left ventricular ejection fraction. Emergent coronary angiography revealed significant proximal stenosis of the left anterior descending artery (LAD) (Picture B, arrow). He underwent percutaneous coronary intervention (Picture C) and was discharged without complications. Wellens syndrome is an abnormal electrocardiographic pattern in a pain-free state with deeply inverted T waves in the precordial leads secondary to proximal LAD stenosis (1). Cardiac enzymes are usually normal or slightly elevated. Three-quarters of untreated Wellens syndrome patients developed LAD occlusion a few weeks after admission (2). Therefore, even in the absence of chest pain or cardiac enzyme elevation, physicians should consider performing coronary angiography and revascularization in cases of Wellens syndrome.
Picture.
The authors state that they have no Conflict of Interest (COI).
References
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