Wellens' Syndrome: A Sign of Impending Myocardial Infarction

Wellens' pattern is an electrocardiogram (EKG) finding of biphasic or deeply inverted T waves in leads V2 and V3 that is suggestive of anterior wall ischemia classically reflecting critical stenosis of the proximal left anterior descending artery (LAD). This pattern reflects a preinfarction state that can eventually progress to massive and fatal anterior wall myocardial infarction (MI). We describe a case of a 50-year-old male who presented with chest pain and hypertensive emergency. EKG revealed new biphasic T-waves in V2-V5. The patient's chest pain resolved with blood pressure control, however, the persistence of Wellens' pattern on EKG prompted further investigation. Emergent left heart catheterization (LHC) revealed severe multivessel coronary artery disease, most notably with critical stenosis of the mid-LAD. The patient underwent successful surgical revascularization. This case highlights a classic EKG pattern that can have serious morbidity and mortality if it is missed. This case also describes a unique anatomical correlation of Wellens' syndrome as the coronary lesion was identified in the mid-LAD, contrary to lesions typically identified in the proximal LAD. Prior knowledge about Wellens' pattern allowed us to consider the possibility of critical LAD stenosis, which allowed for timely intervention and prevention of a massive myocardial infarction and possibly death.