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A warning sign

Sandeep Patri1, Soji Joseph2, Yashwant Agrawal3

  • 1Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.

European Journal of Internal Medicine
|August 25, 2016
PubMed

Insights

Recognizing Wellens' syndrome, characterized by specific EKG changes, is crucial for preventing acute myocardial infarction. Prompt intervention based on these findings can avert significant cardiac damage.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Electrocardiography

Background:

  • Atrial fibrillation with rapid ventricular rate can present with chest pain.
  • Atypical chest pain requires thorough diagnostic evaluation, including electrocardiography (EKG).

Observation:

  • A 64-year-old male presented with atypical chest pain and was found to have atrial fibrillation with rapid ventricular rate.
  • EKG revealed biphasic T wave inversions in leads V2 and V3 after initial treatment for atrial fibrillation.
  • Cardiac biomarkers showed minimal elevations, initially suggesting non-ST elevation myocardial infarction.

Findings:

  • Wellens' syndrome, indicated by specific EKG T-wave abnormalities (biphasic or inverted), was identified.
  • Coronary angiogram demonstrated a critical 90% occlusion in the proximal Left Anterior Descending (LAD) artery.
  • Prompt recognition and intervention prevented acute myocardial infarction (MI).

Implications:

  • Early identification of Wellens' syndrome via EKG is vital for timely intervention.
  • Emergent coronary revascularization can prevent myocardial infarction and subsequent left ventricular dysfunction.
  • Clinicians must be vigilant for Wellens' pattern to guide urgent management strategies.

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