From Wellens' syndrome to acute anterior myocardial infarction, what is required? Only time!

Abstract

The hallmark of Wellens' syndrome is a distinct modification in the precordial T wave of the electrocardiogram (ECG), which usually indicates substantial stenosis of the proximal left anterior descending artery (LAD). Patients with Wellens' syndrome commonly do not exhibit any symptoms of chest pain. This current case report describes a male patient in his early 60s who presented with sporadic chest pain who was subsequently diagnosed with Wellens' syndrome-related electrocardiographic abnormalities. In the precordial leads V2-V5, an inverted symmetric T wave was visible on the asymptomatic ECG. The inverted symmetric T wave of the precordial lead V2-V5 reverted back to being upright when the chest pain started. A follow-up ECG performed before emergency surgery revealed ventricular premature beats and an increase of 0.1-0.5 mV in the ST segment of the precordial leads V1-V5. A drug-eluting stent was inserted after the patient's coronary angiography revealed proximal stenosis of the LAD. To prevent acute myocardial infarction, emergency physicians must identify the ECG signs of Wellens' syndrome and treat high-risk patients with revascularization as soon as feasible. Early recognition and proactive intervention are crucial, as they may help to alleviate adverse consequences.

Keywords: Wellens’ syndrome; acute anterior myocardial infarction; left anterior descending artery.

Figure 1.

Electrocardiograms (ECG) of a male patient in his early 60s who presented with intermittent compression chest pain for 3 days, as well as radiating pain in his shoulders and back: (a) ECG when the patient first arrived in the emergency room revealed a deep inverted symmetric T wave in the precordial leads V2–V5; (b) ECG during chest pain attacks revealed that the inverted symmetric T wave of the precordial lead V2–V5 reverted back to being upright, accompanied by ventricular premature beats; (c) ECG prior to stenting revealed precordial leads V1–V5 ST segment elevation of 0.1–0.5 mV, accompanied by ventricular premature beats, which suggested acute anterior ST segment elevation myocardial infarction and (d) ECG after stenting showed evidence of an anterior myocardial infarction.

Figure 2.

Coronary angiography of a male patient in his early 60s who presented with intermittent compression chest pain for 3 days, as well as radiating pain in his shoulders and back: (a) coronary angiography prior to stenting showed severe coronary artery disease affecting the proximal left anterior descending artery (LAD) and (b) post-stenting coronary angiography with LAD detail.