Omnious T-wave inversions: Wellens’ syndrome revisited

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.

Uncommon Variant of Wellens’ Syndrome: A Case Report and Review of Literature

“…WS was first described by Gerson et al in 1980 as an inverted U-wave, and again in 1982 by De Zwaan, Wellens and colleagues as WS [1,2,4] . It is an uncommon condition to the medical practice because it accounts for 10-15% of all acute coronary syndromes [3] . However, recognizing the syndrome is crucial.…”

“…It is typically diagnosed in a patient with a history of chest pain presenting during a pain-free interval, with an ECG showing biphasic or deep inverted symmetric T waves in the anterior precordial leads [1,2] . The condition carries significant diagnostic and prognostic values because it represents a pre-infarction stage [3] .…”

“…Moreover, there are two types of WS. Type A accounts for approximately 25% of all cases and refers to the classical biphasic T waves in leads V2 and V3, whereas type B accounts for 75% of cases and refers to symmetric deep T wave inversions in the same leads [3,6] . In both cases, cardiac enzymes are first normal or mildly elevated and ECG changes are detected during a pain-free period and exclude pathologic Q waves.…”

“…Based on the above mentioned criteria, the positive predictive value of WS is approximately 86% [3] . Another study by Haines et al reported a specificity of 89% [7] .…”

“…Of patients admitted with unstable angina, this ECG pattern is seen in 14-18% [1,2] . It is a serious syndrome because it represents a pre-infarction stage [3] . We herein report the case of a 48-year-old man with a rare ECG pattern of WS not limited to V2 and V3, but also involving the lateral precordial leads, who was found to have a critical proximal LAD lesion that was successfully stented.…”