Pseudo-Wellens Syndrome in a Patient with Hypertension and Left Ventricular Hypertrophy

Abstract

Patient: Male, 61Final Diagnosis: Left ventricular hypertrophySymptoms: Chest painMedication: —Clinical Procedure: Coronary angiography • echocardiogramSpecialty: CardiologyObjective:Challenging differential diagnosisBackground:Wellens syndrome is a form of unstable angina that warrants a timely intervention to prevent extensive myocardial infarction. A few conditions can lead to electrocardiogram (EKG) changes mimicking Wellens syndrome.Case Report:A 61-year-old African American man with no significant medical history was admitted for chest pain and new biphasic EKG changes in leads V2 through V6 concerning for Wellens’ syndrome. He was found to have hypertension during his hospitalization and had left ventricular hypertrophy by echocardiogram. He was urgently evaluated with a cardiac catheterization, which demonstrated a normal coronary artery anatomy. The patient was diagnosed with pseudo-Wellens syndrome.Conclusions:LVH secondary to hypertension could mimic Wellens syndrome and should be considered when evaluating patients with anterior T wave abnormalities on electrocardiograms. In patients who do not have acute coronary syndrome and in whom the T wave abnormalities are not classic for Wellens-type changes, non-invasive imaging instead of cardiac catheterization may be indicated initially.

Wellens' Syndrome: A Sign of Impending Myocardial Infarction

“…Obtaining a thorough history is also important because there are a few factors that can cause pseudo-Wellens’ syndrome. Patients with pseudo-Wellens' syndrome have the characteristic Wellens’ pattern on EKG, but they will have normal coronary anatomy on further investigation [ 7 ]. Pseudo-Wellens’ syndrome has been associated with cocaine, heavy marijuana use, acute cholecystitis, and Takotsubo cardiomyopathy [ 7 ].…”

Pseudo-Wellens syndrome from sepsis-induced cardiomyopathy: a case report and review of the literature

“…2018 [ 4 ] Pulmonary embolism 22, M Chest pain, not reported Not reported Normal Not performed Grautoff et al . 2019 [ 19 ] Acute cholecystitis 54, M Epigastric pain, not reported Not reported Not reported Not performed Muhailan and Al-Shbool 2019 [ 20 ] Nivolumab/ipilimumab 70, M Syncope, not reported 2 weeks 1.94 Normal Ola and Tak 2019 [ 21 ] HTN and LVH 61, M Chest pain, 3 days When hypertension resolved Normal Normal Effoe et al . 2019 [ 22 ] Acute pancreatitis 45, M Chest pain, When chest pain resolved (24 hours) Normal Anomalous origin of the dominant RCA from the opposite sinus Ju et al .…”

Pseudo-Wellens’ syndrome type A in asymptomatic severe hypertension at a rural emergency department

“…Eight of which demonstrated a biphasic T wave pattern in the precordial leads consistent with a Wellens' type A ECG pattern. Only one case reported demonstrating an association with hypertension and left ventricular hypertrophy [5]. Out of those eight, six cases underwent a cardiac catheterization and one case received a coronary angiography CT scan.…”