Wellen’s Syndrome Like Pattern on a Healthy Roller Skate Athlete : A Case Report

Author : E. D. Hargiyanto, D. Hertriwibowo.
Upload Date : 19-04-2018

Background: Wellen’s syndrome is an electrocardiographic manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis in patients with unstable angina. It is characterized by symmetrical, often deep (>2 mm), T-Wave Inversion (TWI) in the anterior precordial leads. A less common variant is biphasic TWI in the same leads. The aim of this case report is to investigate whether the Wellen's Syndrome like pattern on this athlete is considered abnormal or not.

 Methods: A 25-years-old roller skates athlete who is in regional sport training center was undergo medical check up. The examinations were include physical examination, electrocardiogram, treadmill test and echocardiography.

Results: This athlete did not complaint about chest pain. Physical examination was revealed heart rate of 67 bpm, respiration rate of 12x per minute, and body temperature of 36,20C. Auscultation revealed no wheezing, rhonchi or murmur. Electrocardiogram showed biphasic TWI in anterior and inferior leads. Treadmill test showed total exercise time 13:52; Max HR 146 bpm; Max BP 110/70; Maximum workload: 10.60 METS; Reason for termination: 75% MHR; Summary: Resting ECG: TWI. Chest pain: none. Conclusion: normalizing anterior TWI and persistent inferior TWI. Echocardiography showed within normal limit (resting)

Discussion: Wellen’s Syndrome is highly spesific for a critical stenosis of the LAD artery. However, anterior TWI in leads V1–V2/V3 is recognized pattern in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). In this case, concurrent findings of J-point elevation or biphasic T waves more likely represents athlete’s heart rather than ARVC. TWI inferior cannot be attributed to physiological remodeling and thus warrants further examination such as cardiac MRI. In subjects with resting TWI in the absence of coronary artery disease, in which other unknown mechanisms may be implicated, the exercise testing can induce normalization of TWI related to the sympathetic activation.

KEYWORDS : wallen’s syndrome,treadmill test,echocardiography,athlete’s heart

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