Wellens' Syndrome Presenting as Epigastric Pain and Syncope: An Unusual Presentation

Abstract

Wellens' syndrome, also regarded as left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending artery (LAD) stenosis. It is characterized by deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads in a patient with unstable angina. Patients typically present with symptoms consistent with acute coronary syndrome. We present a unique case of Wellens' syndrome with no angiographic findings of significant stenosis in the proximal LAD but with significant occlusion of the proximal circumflex artery and initial presentation with a chief complaint of epigastric pain and syncope. Physicians need to recognize these characteristic EKG changes during the pre-infarction stage, as they represent myocardial necrosis. Many of these patients eventually develop extensive anterior myocardial infarction with marked left ventricular dysfunction and death if coronary angiography and coronary revascularization are not performed within a few weeks. If Wellens' is seen, patients should undergo urgent cardiac catheterization.

Keywords: cardiac catheterization; electrocardiography; left anterior descending stenosis; myocardial infarction; wellens' syndrome.

Figure 1. EKG showing T-wave inversions in V2-V6 with deep symmetric inverted T-waves in leads V3 and V4

EKG: electrocardiogram

Figure 2. Coronary angiogram showing 85% stenosis of the proximal circumflex

Figure 3. Coronary angiogram showing excellent angiographic appearance with 0% residual stenosis in the proximal circumflex following the placement of a drug-eluting stent

Figure 4. Shows biphasic T-waves in V2 to V3 and T-wave inversion in V4 and V5