Wellen’s Syndrome: A Rare Case

Abstract

Wellen’s syndrome is associated with critical stenosis of the left anterior descending coronary artery. Based on the electrocardiography (ECG) pattern, Wellen’s syndrome can be classified into type 1 (deeply inverted T-waves, mainly in lead V2 and V3) or type 2 (biphasic T-waves). T-wave abnormalities are often also found in V1 and V4 and rarely in V5 and V6. The pattern of ECG changes correlates with proximal left anterior descending artery stenosis. This characteristic ECG pattern is a sign of impending myocardial infarction and is equivalent to ST-elevated myocardial infarction. Often, these subtle findings in ECG get misinterpreted or the severity associated with this goes unrecognized. Hence, for emergency physicians, it is important to recognize such uncharacteristic ECG changes for better and timely management of patients. We present this case of Wellen’s pattern in which the coronary lesion was in the left circumflex coronary artery, right coronary artery, and diagonal-1.

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

“… Arshad et al (2020) [ 3 ], Nagdev et al (2022) [ 4 ], Khattar et al (2023) [ 5 ], Wang et al (2018) [ 6 ], Jayasekara and Weerakoon (2016) [ 7 ], Parekh et al (2022) [ 8 ], Kim et al (2020) [ 9 ], Avram et al (2021) [ 10 ], Jaiswal and Boudreau (2016) [ 11 ], Natarajan (2020) [ 12 ], Elkholy et al (2021) [ 13 ], Ajibawo et al (2020) [ 14 ], Torelli et al (2020) [ 15 ], Di Stolfo et al (2015) [ 16 ], Mufti et al (2018) [ 17 ], Yazdi and Sharim (2019) [ 18 ], Yang et al (2023) [ 19 ], Plappert et al (2022) [ 20 ], Tan et al (2017) [ 21 ], Khan et al (2013) [ 22 ], Shah et al (2021) [ 23 ], Hollar et al (2015) [ 24 ], Obi et al (2023) [ 25 ], Mathew et al [ 2 ] …”

“…This review indicated that although Wellens’ syndrome is seen mostly involving the LAD, it is not limited to it, as coronary artery blockages with Wellens’ syndrome pattern of ECG presentation that met diagnostic criteria can be seen in the LCX and RCA as part of a multi-coronary proximal artery occlusion. Most patients examined in this study had an unusual presentation of symptoms during a pain-free period, with the underlying pathophysiology linked to stenosis, reperfusion, and reocclusion of coronary vessels [ 4 ]. Despite the variability in the level of coronary artery involvement, this systematic analysis of selected primary research highlights the importance of early intervention, such as the utilization of an ECG followed by coronary artery angiogram (CAG), particularly in patients with significant risk factors for coronary artery disease upon presentation.…”