Wellens syndrome progressing from a very subtle type A to a classic type B Wellens pattern

Wellens syndrome is a well-known clinical syndrome characterized by specific electrocardiographic (ECG) patterns that is usually suggestive of a critical proximal left anterior descending (LAD) coronary artery stenosis and requires early revascularization. There are two Wellens ECG patterns (A and B) described in the literature. It was suggested that Wellens syndrome can evolve from pattern A into pattern B, however, there is paucity of reported cases that described this phenomena. We report a case of Wellens syndrome that initially presented with very subtle ECG T wave changes suggestive of Wellens pattern A that progressed into classic pattern B with T wave inversions. A very low threshold of suspicion and serial ECGs were imperative to the early recognition of such a critical cardiovascular disease.