Dangerousness: T-wave pseudonormalization in a patient with Wellens' syndrome: A case report
Meixian Lei1,2, Mingqing Yuan1,2, Ling Gao1,2
1Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People's Hospital, Jiujiang, Jiangxi, China.
Rationale:
Wellens' syndrome electrocardiogram (ECG) pattern consists of symmetrically inverted (or biphasic) T waves in the precordial leads, frequently in V2-V3, which is associated with critical stenosis of the left anterior descending (LAD) coronary artery and impending myocardial infarction. Timely diagnosis and early treatment of Wernicke's syndrome are of utmost importance. Here, we present the clinical characteristics and treatment outcomes of patients with Wellnes' syndrome.
Patient Concerns:
A 62-year-old male presented with intermittent chest pain for 6 days while resting, accompanied by chest tightness and sweating. On admission, the patient had no chest pain, vital signs were stable, and physical examination revealed no positive findings. ECG after admission revealed a normal sinus rhythm with poor progression of R waves in the precordial leads. Blood count, biochemical tests, and cardiac biomarkers were all within normal ranges. The patient's ECG before admission revealed biphasic T waves in leads V2-V6.
Diagnoses And Interventions:
Dual antiplatelet, nitrate, and statin drugs were administered and the patient underwent urgent coronary angiography. The results revealed that the proximal LAD coronary artery was nearly completely occluded. Intravascular ultrasonography confirmed plaque rupture with thrombosis in the proximal LAD artery, with a minimum lumen area of 2.4 mm2. The patient was diagnosed with Wellens' Syndrome. A drug-eluting stent was successfully implanted following balloon dilatation.
Outcomes:
The left ventricular ejection fraction and reexamination levels of troponin T and B-type natriuretic peptides were normal after the operation. The patient was discharged 6 days later.
Lessons:
Enhancing physicians' awareness of the electrocardiographic patterns associated with Wellens' syndrome facilitates the early identification of this condition, enabling the timely initiation of pharmacological and revascularization treatments for acute coronary syndrome. This proactive approach effectively mitigates the risk of acute myocardial infarction in patients and significantly improves their prognoses.
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