Wellens' Syndrome in the Setting of the 2019 Novel Coronavirus (COVID-19)

Abstract

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-Cov2), is the causative pathogen of coronavirus disease 2019 (COVID-19), which is primarily described as a respiratory illness. However, a wide array of cardiovascular complications has also been described in the setting of COVID-19. Wellens' syndrome, also regarded as a left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending (LAD) artery stenosis. It is characterized by deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads in a patient with unstable angina. Patients typically present with symptoms consistent with acute coronary syndrome. To our knowledge, we present the first case of Wellens' syndrome in a patient with a COVID-19 infection. Furthermore, this case describes stenosis of the left circumflex artery, a variant of the unusual angiographic findings associated with Wellens', as it is usually associated with occlusion of the proximal LAD. The pathophysiology of cardiovascular complications associated with COVID-19 is not wellunderstood; nevertheless, it was reported that mortality from coronary artery disease (CAD) complications is significantly higher in these patient populations. Healthcare providers should also be aware of identifying Wellens' syndrome, as urgent coronary angiography is superior to stress testing.

The Comparative Assessment of Wellens’ Syndrome With Proximal Left Anterior Descending Artery (LAD) Stenosis Versus Right Coronary Artery (RCA) or Circumflex Coronary Artery Stenosis and Its Prevalence: A Systematic Review

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Myocardial Ischemia in Patients with COVID-19 Infection: Between Pathophysiological Mechanisms and Electrocardiographic Findings

“…Regarding the therapeutic approach, we observed a difference during the pandemic. If the first published case of Wellens syndrome did not receive an angiography because of the COVID-19 status and the risk of infection, Caiati et al, the authors who published the latest case of Wellens syndrome during the COVID-19 pandemic, chose another therapeutic approach and the patient underwent an angiography [ 136 , 137 , 138 , 139 ]. This may be due to the fact that at the beginning of the pandemic, information about COVID-19 was scarce, a conservatory treatment was preferred in order to keep as little physical contact as possible.…”