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Intermittent Typical Angina: Remember Wellens' Syndrome
1Division of Cardiology, University of Catania, Catania, Italy.
Advanced Journal of Emergency Medicine
|August 15, 2019
Summary
Wellens' syndrome (WS) is a critical indicator of potential acute coronary syndrome, often presenting with subtle ECG changes. Early recognition and intervention are vital to prevent severe myocardial infarction.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Wellens' syndrome (WS) is a specific electrocardiogram (ECG) pattern indicative of critical coronary artery stenosis.
- Early identification of WS is crucial for preventing acute myocardial infarction.
Observation:
- A 65-year-old male presented with intermittent chest pain and unremarkable initial physical examination and chest X-ray.
- Electrocardiogram revealed biphasic T-waves in precordial leads (V1-V4) and pseudo-normalization during pain episodes.
- Slightly elevated cardiac biomarkers (hs-cTnT, CK-MB) without further increase prompted further investigation.
Findings:
- Coronary angiography identified a significant lesion in the proximal left anterior descending artery.
- The case highlights WS in a patient without prior cardiovascular disease history.
- Serial ECG monitoring is essential for diagnosing acute coronary syndrome associated with WS.
Implications:
- WS diagnosis and management present challenges, underscoring the need for vigilance.
- Awareness of subtle WS features can prevent the misdiagnosis and discharge of high-risk patients.
- Prompt coronary angiography and treatment are mandatory to avert extensive anterior myocardial infarction.