Uncommon LAD Coronary T-Wave Inversion : Wellens’ Syndrome : A Case Report

Author : M.R. Felani, M.N. Adhitya, S. Revan, M.F. Yusuf, M.W. Hadi, S. Khairunnisa, M.N. Afif, S.F. Liliana
Upload Date : 19-04-2018

Introduction: Wellens' Syndrome is characterized by an electrocardiographic (ECG) pattern of T-wave changes associated with critical stenosis of left anterior descending (LAD) artery. Urgent cardiac catheterization is vital to prevent further myocardial injury. We are presenting an uncommon case of Wellens' Syndrome, which the patient had been sent for cardiac catheterization before myocardial infarction did develop.

Case Description: A 40-year-old male admitted to emergency room with transient squeezing left chest pain since two weeks ago, deep and symmetrical T-waves inversion in V1-V6 (with very subtle ST Elevation in V1-V4 and normal Q waves), normal cardiac troponin, and normal left ventricular ejection fraction (70% of LVEF). He was given an acute coronary syndrome protocol, and escorted to cardiac cath lab soon for coronary angiography. He had a 90% stenosis in mid-LAD, and was submitted to percutaneous coronary intervention.

Discussion: The spectrum of Wellens' syndrome is very wide, and  high clinical suspicion for its diagnosis, especially in its rarest presentation of precordial ECG finding (Type B of Wellens’s Syndrome in this case), is an important role to avoid terrible consequences. With coronary intervention as a definitive management of the case, the improvements obtained with normalization of patient’s precordial ECG finding, and all of his clinical symptoms had fully relieved.

Conclusion: It is very important for general physicians to recognize the typical ECG findings of Wellens' Syndrome, because it is considered as a specific marker for critical LAD occlusion and high risk for incoming anterior wall myocardial injury. There will be significant morbidity and mortality that can occur without urgent coronary revascularization.

KEYWORDS : Wellens’ syndrome, myocardial injury, coronary intervention

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