28 January 2019 : Case report
A Pathognomonic Electrocardiogram That Requires Urgent Percutaneous Intervention: A Case of Wellens Syndrome in a Previously Healthy 55-Year-Old Male
Mistake in diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Dilpreet Singh1BDEF*, Idrees Suliman1BEF, Iryna Chyshkevych1E, Nemer Dabage1EDOI: 10.12659/AJCR.912056
Am J Case Rep 2019; 20:117-120
Abstract
BACKGROUND: Acute chest pain is a common presentation in emergency departments worldwide. Ruling out acute coronary syndrome is essential in ensuring patient safety. Workup includes electrocardiogram (ECG) and cardiac biomarkers. Wellens syndrome is characterized by a history of chest pain, normal or minimally elevated biomarkers, no STEMI/Q-waves, and specific ECG changes. These changes consist of biphasic T waves in lead V2 and V3 or deep symmetrically inverted T waves in leads V1–V4.
CASE REPORT: A 55-year-old male presented to the emergency department with acute chest pain in a background of active smoking, hypertension, and hyperlipidemia. His ECG was characteristic of Wellens syndrome type 1 and negative cardiac biomarkers. His TIMI (thrombolysis in myocardial infarction) score was 2, however, he failed conservative management necessitating urgent coronary angiogram. Critical stenosis of the proximal left anterior descending (LAD) coronary artery was found which required 2 drug eluting stents. He was discharged home asymptomatic on optimal medical therapy.
CONCLUSIONS: Conventional management of patients with NSTEMI (non-ST-elevation myocardial infarction) and unstable angina with risk stratification utilizing TIMI score may not be appropriate in patient with Wellens syndrome. This highlights the importance of ECG recognition and urgent percutaneous intervention in patients with Wellens syndrome. Failure to identify this clinical syndrome could result in significant morbidity and mortality because it relates to critical stenosis and imminent large myocardial infarction.
Keywords: acute coronary syndrome, Electrocardiography, percutaneous coronary intervention, Chest Pain, Coronary Stenosis, Hyperlipidemias, Hypertension, smokers, Syndrome
In Press
Case report
Rare Case of Fusobacterium necrophorum Bacteremia and Pleural Empyema Originating from a Burn Ulcer in a 16...Am J Case Rep In Press; DOI: 10.12659/AJCR.945283
Case report
Acute Epiploic Appendagitis Mimicking Ovarian Torsion: A Case Report Highlighting Diagnostic ChallengesAm J Case Rep In Press; DOI: 10.12659/AJCR.944870
Case report
Rapid Recovery After Full Sternotomy Off-Pump Coronary Artery Bypass Grafting in Complex Cases: A Report of...Am J Case Rep In Press; DOI: 10.12659/AJCR.946043
Case report
Adrenal PEComa Treated by Surgical Resection and Postoperative Radiotherapy: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.945177
Most Viewed Current Articles
21 Jun 2024 : Case report 78,043
Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report 46,099
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report 32,953
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
23 Feb 2022 : Case report 21,399
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250