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Case Reports
. 2013 Mar 31;6(3):122-5.
doi: 10.4066/AMJ.2013.1636. Print 2013.

A dangerous twist of the 'T' wave: A case of Wellens' Syndrome

Kavitha Balasubramanian  1 , Ramachandran Balasubramanian, Anandaraja Subramanian
Affiliations
Case Reports

A dangerous twist of the 'T' wave: A case of Wellens' Syndrome

Kavitha Balasubramanian et al. Australas Med J. .

Abstract

Wellens' syndrome is a condition in which electrocardiographic (ECG) changes indicate critical proximal left anterior descending artery narrowing occurring during the chest pain-free period. Due to the severity of the obstruction, if such cases are managed by early invasive revascularisation therapy, a major threat in the form of a massive myocardial infarction or sudden death may be averted. We present the case of a patient with previous chest pain, whose ECG showing subtle ischemic changes was initially overlooked. A repeat ECG taken during the painless period showed a biphasic T wave, suggestive of Wellen's' syndrome. This was confirmed by an immediate coronary angiogram.

Keywords: Wellens’ syndrome; electrocadiographic changes; left anterior descending artery obstruction; revascularisation.

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Figures

Figure 1
Figure 1. This ECG taken during the chest pain shows very subtle prominence of T wave in the precordial leads V2 and V3.
Figure 2
Figure 2. This ECG taken after 24hrs during pain-free interval, shows a biphasic T wave pattern in V2, V3 and V4. There is little or no ST elevation and a characteristic acute angle ST – T. The R wave progression is normal with no demonstrable pathological Q waves.
Figure 3
Figure 3. A still from the CAG shows 100% block in the proximal LAD artery due to a thrombus, indicated by the arrow mark.
Figure 4
Figure 4. A still from the CAG showing normalisation of flow in the LAD post PTCA.
Figure 5
Figure 5. The ECG taken after PTCA and stenting shows normalisation of the biphasic T waves in leads V2, V3 and V4.
Figure 6
Figure 6. Comparison of the ECGs taken during the chest pain, during the pain-free interval and post-stent placement.
None
See this image and copyright information in PMC

References

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