Troponin is Not Everything, a Difficult Diagnosis That Should be Kept in Mind: Wellens' Syndrome

Abstract

ABS TRACT Chest pain is one of the most common problems evaluated in the emergency department (ED). In addition to physical examination, electrocardiography (ECG) and cardiac biomarkers are often used in the initial assessment of patient in ED. Wellens' syndrome is characterized by electrocardiographic T-wave changes especially in leads V2-V3 with severe proximal stenosis of the left anterior descending artery (LAD). We report a Wellens' syndrome case which acute anterior myocardial infarction developed after 7 hours later since after the first emergency contact. It is important to rapidly and accurately risk-stratify patients with suspected acute coronary syndrome. Especially emergency physicians must be aware of negative T wave in leads V2-V3 on ECG and must know that only one normal troponin value alone does not exclude the diagnosis of acute coronary syndrome. It is very important to recognize Wellens' syndrome early, as it allows rapid invasive intervention for cardiologist and cardiovascular surgery, so that extensive myocardial infarction can be prevented and perhaps a life can be saved.