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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.

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|August 25, 2016
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Summary
This summary is machine-generated.

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.

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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.