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Early Diagnosis and Prompt Treatment of Severe Stenosis in The Proximal Left Anterior Descending Coronary Artery: Wellens’ Syndrome Case Report

Author : H. R. S. Dhilion, Haikal, B. Pamungkas, A. Harsoyo, V. Pratama
Upload Date : 19-04-2018

Background:Ischemic heart disease is the greatest cause of mortality and disability-adjusted life years worldwide. The electrocardiography misinterpretation occurs in 20-40% of misdiagnosed myocardial infarction. Wellens's syndrome has a typical T-wave changes that indicate severe stenosis in the proximal left anterior descending (LAD) artery, leading to extensive anterior myocardial infarction within days. Thus showing the importance of early diagnosis of this syndrome

Case illustration: A 58-year-old man presents to Indonesia Army Central Hospital Gatot Soebroto emergency department complaining typical angina lasting for about six hours and accompanied with diaphoresis. He gave a history of several episodes of similar pain which occurred at rest over the prior month. Each episode lasting about 30 minutes. He was usually given only injections for stomach problems at every hospital he visited. Coronary artery disease risk factors in this patient were smoking, family history and dyslipidemia. His vital sign was within normal limit. The electrocardiography shows sinus rhythm with T-wave inversion in I, aVL,V2 leads, and deep T-wave inversion in V3-V6 leads. His cardiac enzyme was within normal limit. He was then diagnosed unstable angina pectoris TIMI score 2 with refractory chest pain. We consider patient’s ECG showing a Wellens’ syndrome. The patient is performed early percutaneous coronary angiography and the result is subtotal occlusion of 99% in proximal LAD artery, then coronary intervention was performed with drug-eluting stent (DES) implantation with a good result.                                                

Conclusion: Physicians must be proficient at diagnosing acute coronary syndrome. Wellens’ syndrome is a non-classical ischemic ECG findings which consist of biphasic T wave or deep T wave inversions in precordial leads. Most patients, when identified early and taken for cardiac catheterization, do well after proper intervention. Cardiac stress tests should not be performed in this condition.

KEYWORDS : wellens’ syndrome, deep T-wave inversion, severe stenosis of LAD artery

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