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Omnious T-wave inversions: Wellens ’ syndrome revisited

View Article: PubMed Central - PubMed

ABSTRACT

Wellens’ syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens’ syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI. Here, we report a case of an overweight man with 35 pack-year of smoking history who presented to Easton Hospital with intermittent pressing chest pain of 5/6 times within 10 day-period and was found to have type A Wellens’ sign, which was biphasic T-waves in precordial leads V2 and V3 during pain-free period with no cardiac enzymes elevation. He was given therapeutic lovenox and subsequently underwent coronary angioplasty and had 95–99% occlusion in proximal LAD artery. The unique feature of our case was that Wellens’ type B EKG changes were seen after reduction of stenosis with LAD artery stent, which was likely explained by the reperfusion of the ischemic myocardium. Therefore, it is important for physicians to recognize EKG features of Wellens’ syndrome in order to take appropriate therapy to reducing mortality and morbidity form impending MI.

No MeSH data available.


EKG before stent placement, showing biphasic T-waves in leads V2 and V3.
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Figure 0001: EKG before stent placement, showing biphasic T-waves in leads V2 and V3.

Mentions: A52-year-old Caucasian male, with a past medical history significant only for a 35 pack-year current smoking history, presented with severe intermittent sub-sternal chest pain for 2 weeks’ duration. The chest pain occurred with exertion and relieved with rest. Upon arrival to the emergency department (ED), he had continued pain and vital signs were within normal limits. Physical examination was unremarkable. Electrocardiogram (EKG) was performed and demonstrated sinus tachycardia with biphasic T-waves in V2 and V3 without pathologic Q-waves (Fig. 1), typical of the Wellens’ sign.


Omnious T-wave inversions: Wellens ’ syndrome revisited
EKG before stent placement, showing biphasic T-waves in leads V2 and V3.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016748&req=5

Figure 0001: EKG before stent placement, showing biphasic T-waves in leads V2 and V3.
Mentions: A52-year-old Caucasian male, with a past medical history significant only for a 35 pack-year current smoking history, presented with severe intermittent sub-sternal chest pain for 2 weeks’ duration. The chest pain occurred with exertion and relieved with rest. Upon arrival to the emergency department (ED), he had continued pain and vital signs were within normal limits. Physical examination was unremarkable. Electrocardiogram (EKG) was performed and demonstrated sinus tachycardia with biphasic T-waves in V2 and V3 without pathologic Q-waves (Fig. 1), typical of the Wellens’ sign.

View Article: PubMed Central - PubMed

ABSTRACT

Wellens’ syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens’ syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI. Here, we report a case of an overweight man with 35 pack-year of smoking history who presented to Easton Hospital with intermittent pressing chest pain of 5/6 times within 10 day-period and was found to have type A Wellens’ sign, which was biphasic T-waves in precordial leads V2 and V3 during pain-free period with no cardiac enzymes elevation. He was given therapeutic lovenox and subsequently underwent coronary angioplasty and had 95–99% occlusion in proximal LAD artery. The unique feature of our case was that Wellens’ type B EKG changes were seen after reduction of stenosis with LAD artery stent, which was likely explained by the reperfusion of the ischemic myocardium. Therefore, it is important for physicians to recognize EKG features of Wellens’ syndrome in order to take appropriate therapy to reducing mortality and morbidity form impending MI.

No MeSH data available.