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Case Reports
. 2018 Dec 19;11(1):e227464.
doi: 10.1136/bcr-2018-227464.

Pseudo-Wellens' syndrome in pulmonary embolism

Yub Raj Sedhai  1 , Soney Basnyat  2 , Priyanka T Bhattacharya  3
Affiliations
Case Reports

Pseudo-Wellens' syndrome in pulmonary embolism

Yub Raj Sedhai et al. BMJ Case Rep. .

Abstract

Wellens' syndrome is described as characteristic biphasic or symmetrical T-wave inversion with normal precordial R-wave progression and the absence of Q waves in the right precordial leads. It is seen during chest pain-free interval in a subset of patients with unstable angina. Wellens' syndrome is associated with critical stenosis of proximal left anterior descending (LAD) coronary artery. Similar characteristic ECG changes associated with causes other than LAD stenosis have been described as pseudo-Wellens' syndrome. In this case report, we present a young 22-year-old man who presented with characteristic Wellens' ECG changes in the setting of pulmonary embolism with right ventricular strain. T-wave inversion in right precordial leads is a well-recognised ECG manifestation of right ventricular strain; however, biphasic T waves in the setting of pulmonary embolism are rare. Pulmonary embolism was seen in our patient a week after starting risperidone. There is a reported association between antipsychotic drugs and increased risk of thromboembolism. Risperidone could have potentially contributed to the pulmonary embolism in our patient given the temporal association and absence of risk factors.

Keywords: psychiatry (drugs and medicines); venous thromboembolism.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ECG during pain-free interval showing biphasic T waves in leads V2 and V3.
Figure 2
Figure 2
ECG showing resolution of biphasic T waves during chest pain.
Figure 3
Figure 3
CT angiography of the chest showing pulmonary embolus (marked with red arrow).
Figure 4
Figure 4
CT angiography of the chest showing enlarged right ventricular cavity with straightening of the interventricular septum (marked with red arrow).
See this image and copyright information in PMC

References

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