Two case reports of Wellens’ syndrome

Abstract

Wellens’ syndrome is characterised by particular changes in electrocardiogram (ECG) precordial lead T-waves accompanied by proximal stenosis of the left anterior descending (LAD) artery. Two cases of electrocardiographic changes associated with Wellens’ syndrome are presented here. Case 1, a 55-year-old female, was transferred to the First Affiliated Hospital of Xi’an Jiaotong University with intermittent and laborious angina pectoris. Her first ECG on admission revealed T-wave inversion in leads V1–V3 and biphasic T-waves in V4. Case 2, an 85-year-old female, presented with dyspnoea and paroxysmal chest pain. Her admission ECG displayed asymmetrical T-wave inversion in leads V1–V3, I, and aVL, and depressed ST segments in leads V2–V5. In this patient, drug-eluting stents were placed on a LAD artery lesion and right coronary artery occlusion. The potential of ECGs to aid decision-making in severe myocardial infarction is straightforward, particularly in patients with characteristic ECGs, however, Wellens’ syndrome has a wide spectrum of clinical manifestations and the ECG patterns may manifest itself persistently over a period of weeks. Therefore, ECG parameters should be combined with coronary angiography to confirm the presence of lesions.

Intracranial Hemorrhage Presenting With ST-Segment Elevation and T-Wave Inversion Concerning for Acute Myocardial Infarction

“…Compared to "cerebral T waves," coronary T waves have been described as an upward bowed isoelectric ST segment followed by the symmetric down-stroke of the T wave (Afolabi-Brown et al, , 2014;Hayden, Brady, Perron, Somers, & Mattu, 2002). One exception is the "Wellenoid" T waves of a proximal LAD lesion, which can also have a similar appearance to a "cerebral T wave" (Wang et al, 2018). These T-wave changes, combined with a prolonged QT interval, may be more suggestive of an intracranial as opposed to cardiac etiology (Catanzaro et al, 2008).…”

Wellens Syndrome: A Review Article

“…6 The diagnostic criteria for WS are as follows: deep inverted T waves in leads V2 and V3 (also seen in leads V1, V4, V5, and V6) or biphasic T waves (with initial positivity and negative terminals) in V2 and V3, absence of Q waves without loss of precordial R waves, no significant STsegment elevation (< 1 mm), normal or minimally increased cardiac markers, history of chest pain and T wave changes (biphasic or inverted) in the precordial leads during the pain-free period, as (shown in Figure 1) Inverted or biphasic T-waves in the precordial leads were caused by repolarization abnormalities due to reperfusion injury and myocardial edema. 13,14 It is essential to consider coronary angiograms as an initial diagnostic modality rather than any other conservative examination in a patient with an ECG pattern, suggesting the possibility of WS. 7 An example of common coronary angiography findings in WS which show obstructions in LAD (can be seen in Figure 2).…”

Wellens' Syndrome: A Dangerous Heart Infrequency

“…If significant occlusion of the anterior descending artery is evident, percutaneous coronary intervention or coronary artery bypass surgery should be performed to prevent acute anterior myocardial infarction. When treated with pharmacological therapy alone, 75% of patients with this syndrome develop anterior wall infarction within one week (18) (19) .…”