An Interesting Case of Wellens Syndrome Dissimulating an Acute Coronary Sub-Occlusion

Wellens syndrome is an electric pattern highly specific of critical stenosis of the proximal LAD. It’s defined by abnormalities of T waves in V2-V3 : type 1 (biphasic T waves), type 2 (negative T waves). Wellens also does not show signs of infarction by definition.

Our work is about a young man of 33 yo who accused quickly resolving chest pain. His EKG showed biphasic T waves in V2 V3 V4 and V5 and negative T waves in DI aVL with 0,3mm ST suspension. His T waves kept changing: disappearing in V5 and becoming less negative in other derivations. The cardiac catheterization showed tight lesion of the ostium of proximal LAD artery with a high thrombotic load. Patient was put under glycoprotein IIb/IIIa inhibitors and taken back to the cath-lab 1 week after for PCI (percutaneous coronary intervention) which was successful. 

First we want to discuss electrical findings. T waves inversion extended to V4 V5, which is uncommon. We have also to put forward the abnormalities we found in high lateral territory. Other particularity of our patient is the dynamic EKG showing he was threatening.

Furthermore, definitive treatment typically involves cardiac catheterization with PCI to relieve the occlusion and there’s no place for stress tests.

Wellens syndrome is a real challenge, which is underdiagnosed and needs more attention from emergency physicians. The interest of thrombolysis in this pre-infarction condition still needs to be substantiated.