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Case Reports
. 2016 Sep 7;6(4):32011.
doi: 10.3402/jchimp.v6.32011. eCollection 2016.

Omnious T-wave inversions: Wellens' syndrome revisited

Swe Zin Mar Win Htut Oo  1 , Koroush Khalighi  1   2   3 , Archana Kodali  1 , Cho May  1 , Thein Tun Aung  4 , Richard Snyder  1
Affiliations
Case Reports

Omnious T-wave inversions: Wellens' syndrome revisited

Swe Zin Mar Win Htut Oo et al. J Community Hosp Intern Med Perspect. .

Abstract

Wellens' syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens' syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI. Here, we report a case of an overweight man with 35 pack-year of smoking history who presented to Easton Hospital with intermittent pressing chest pain of 5/6 times within 10 day-period and was found to have type A Wellens' sign, which was biphasic T-waves in precordial leads V2 and V3 during pain-free period with no cardiac enzymes elevation. He was given therapeutic lovenox and subsequently underwent coronary angioplasty and had 95-99% occlusion in proximal LAD artery. The unique feature of our case was that Wellens' type B EKG changes were seen after reduction of stenosis with LAD artery stent, which was likely explained by the reperfusion of the ischemic myocardium. Therefore, it is important for physicians to recognize EKG features of Wellens' syndrome in order to take appropriate therapy to reducing mortality and morbidity form impending MI.

Keywords: T-inversion; Wellens' syndrome; electrocardiographic changes; left anterior descending artery obstruction; myocardial infarction; revascularization.

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Figures

Fig. 1
Fig. 1
EKG before stent placement, showing biphasic T-waves in leads V2 and V3.
Fig. 2
Fig. 2
Coronary angiogram revealing 99% stenosis of proximal left anterior descending artery pre-intervention.
Fig. 3
Fig. 3
Coronary angiogram showing lesion was reduced to zero percent after drug eluting stent placement.
Fig. 4
Fig. 4
EKG 1 day after stent placement, showing deep T-wave inversion in leads V1–V3.
See this image and copyright information in PMC

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