Wellens’ syndrome: a life-saving diagnosis

Abstract

Wellens' syndrome is a relatively common clinical entity; however, it is often missed, especially in young patients. Without prompt diagnosis and aggressive intervention, patients with Wellens' syndrome may rapidly go on to develop extensive anterior wall myocardial infarction and possibly sudden death. In this case report, we present a 33-year-old male patient with atypical chest pain, and discuss the significance of a prompt recognition of Wellens' syndrome.

A Case of Wellens Syndrome in a 30-Year-Old Woman From Sub-Saharan Africa: A Perplexing Clinical Entity With Invaluable Lessons

“…10,13 Wellens syndrome is an ECG manifestation characterized by a pattern of deeply inverted or biphasic T-waves in leads V2 to V3, signifying a critical stenosis of the LAD coronary artery. [1][2][3][4][5][6][7][8][9] Despite of its known diagnostic and prognostic value, recognition of Wellens syndrome remains a challenge to practitioners all over the world. [1][2][3][4][5][6][7][8][9] As demonstrated in this case, a definitive diagnosis was reached on the eighth day since onset of chest pain.…”

“…Since its initial description nearly 4 decades ago, 1 Wellens syndrome, a relatively common and potentially fatal clinical entity, continues to be underrecognized and lately recognized worldwide. [2][3][4] Also referred to as left anterior descending (LAD) coronary T-wave syndrome, this preinfarction stage is characterized by a distinctive electrocardiographic (ECG) pattern (ie, biphasic T-wave inversions on precordial leads) suggestive of a critical stenosis in the LAD coronary artery. [1][2][3][4][5] It is estimated to affect about 10% to 15% of persons with unstable angina, 4,5 three quarters of whom will develop extensive anterior wall myocardial infarctions (MIs) if not revascularized timely.…”

“…The dilemma in recognizing this portentous syndrome lies in (1) inadequate physician skills in ECG interpretation, (2) frequent absence of clear ischemia at initial evaluation, (3) frequent manifestation of the signs during pain-free intervals, and (4) the sharing of the characteristic ECG pattern with several other common clinical conditions including hypokalemia, intracerebral hemorrhage, persistent juvenile T-wave inversion, pulmonary embolism, right bundle branch block, or at times it may be just a normal variant. [1][2][3][4][5][6][7][8][9] With the increasing global prevalence of CAD risk factors in younger populations, 10 an increase in presentation of Wellens syndrome at earlier age is foreseeable. We report the experience and lessons learnt from the first ever documented local case of Wellens syndrome in a 30-year-old woman of African origin from northern Tanzania.…”

Síndrome de Wellens. Reporte y revisión de un caso

“…Its risk factors include a family history of premature coronary heart disease, type II diabetes mellitus, metabolic syndrome, hypertension, smoking, hyperlipidemia, work stress, advanced age 18 (55 ± 9 years), cases associated with HIV, probably due to premature coronary disease 19 and also in patients without cardiovascular risk factors. 20 It is classified into type A and B (1 and 2 respectively). 8 Type A constitutes 24% of cases, it is less common but more specific and less recognized, it presents biphasic T waves in V2 and V3.…”

“…Atypical cases have been described where the type B pattern changes to type A. 22 It should be emphasized that changes in the T wave occur during periods without precordial pain and pseudo normalized during the precordial pain episode, and may persist for hours or weeks 7,23 leading to errors in diagnosis and inadequate risk stratification, so the ability to recognize these patterns is extremely important, since ECG changes can be subtle [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] There are atypical presentations in which there is no precordial pain, only syncope, but the electrocardiographic pattern meets WS criteria. 25 In the case presented, the fact that the patient was asymptomatic at the time of admission to the emergency department, and the taking of an initial electrocardiogram as part of the cardiology evaluation, showed the inversion of T waves in precordial leads from V2 to V6, leading to timely diagnosis confirming it with pseudonormalization during an episode of precordial pain, which occurred spontaneously without maneuvers to cause ischemia.…”