Critical Finding of Wellens' Syndrome in a Patient who Presented With a Fibular Fracture

Diagnosing myocardial infarction is not always straightforward; there are many insidious presentations that can be overlooked resulting in deadly consequences. We present a 76-year-old male who came to the ED complaining of right ankle pain. A routine electrocardiogram (ECG) done was noted to have biphasic T waves in leads V2 and V3 which was characteristic of Wellens' syndrome. Subsequent workup showed an increase in troponin T levels in a chest pain-free setting. The patient underwent urgent cardiac catheterization which showed significant triple vessel coronary artery disease, with 90% proximal occlusion of the left anterior descending artery, eventually requiring coronary artery bypass grafting (CABG). Timely diagnosis and management prevented serious consequences of his underlying severe coronary artery disease.