Wellens' syndrome can indicate high-grade LAD stenosis in case of left bundle branch block

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Diagnosing acute myocardial infarction (AMI) in patients with left bundle branch block (LBBB) presents significant clinical challenges.
• Standard diagnostic criteria for AMI are often unreliable in the presence of LBBB.
• Modified Sgarbossa criteria are established for improving AMI detection in LBBB.

Observation:

• This case report details an electrocardiogram (ECG) exhibiting Wellens' signs in a patient with a pre-existing LBBB.
• The patient presented with fluctuating chest pain, and subtle Wellens' signs on initial ECG became more apparent 24 hours later.
• These ECG findings prompted further investigation.

Findings:

• A diagnosis of high-grade stenosis in the left anterior descending artery (LAD) was made.
• The patient underwent successful treatment for the LAD stenosis.
• Wellens' signs were crucial in identifying significant LAD stenosis, even when modified Sgarbossa criteria were not met.

Implications:

• Wellens' syndrome can be reliably diagnosed in the context of LBBB.
• Recognizing Wellens' signs in LBBB patients can aid in the early detection of critical coronary artery stenosis.
• This finding emphasizes the importance of considering specific ECG patterns beyond standard criteria for accurate diagnosis and timely intervention.