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Recognizing Wellens Syndrome in Emergency Medical Care - A Case Report
Emir Niksic1, Damir Husovic1, Elvira Lukac-Radoncic1
1Emergency Medical Services, Health Center of Novi Pazar, Novi Pazar, Serbia.
Insights
Wellens syndrome, indicated by specific ECG changes, can signal critical left anterior descending artery blockages and risk of heart attack. This case shows these ECG patterns may also appear with multi-vessel coronary artery disease.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Internal Medicine
Background:
- Wellens syndrome presents with specific electrocardiogram (ECG) findings, typically indicating critical left anterior descending (LAD) coronary artery stenosis.
- This condition carries a high risk of myocardial infarction (MI) if left untreated.
- Two ECG patterns, Type A and Type B, are recognized.
Purpose of the Study:
- To report a case of Wellens syndrome.
- To investigate the coronary anatomy in a patient presenting with Wellens-type ECG changes.
- To highlight the potential for Wellens syndrome to occur in the context of multi-vessel coronary artery disease.
Main Methods:
- Case report of a 55-year-old female with chest tightness and shortness of breath.
- Initial and follow-up electrocardiogram (ECG) monitoring.
- Coronary angiography to assess coronary artery anatomy.
Main Results:
- Follow-up ECG showed Wellens Type A pattern (biphasic, inverted T waves in V2-V5).
- Coronary angiography revealed moderate proximal LAD narrowing (40%), mild subocclusion of diagonal branches, 50% stenosis in the left circumflex artery and obtuse marginal branch 2, and significant mid-segment stenosis (70%) in the right coronary artery.
- Findings suggest Wellens-type ECG changes can be associated with multi-vessel coronary artery disease, not solely a critical LAD lesion.
Conclusions:
- Early recognition of Wellens syndrome is critical due to the risk of myocardial infarction.
- Continuous ECG monitoring during chest pain episodes and pain-free intervals is recommended for patients with chest pain.
- Angiographic findings should be interpreted considering the possibility of multi-vessel coronary artery disease.
Abstract:
BACKGROUND Wellens syndrome is a clinical entity characterized by specific electrocardiographic changes, often indicating critical stenosis in the high part of the left anterior descending coronary artery (LAD), posing a high risk for myocardial infarction if untreated. Two electrocardiogram (ECG) patterns are described: Type A and Type B. CASE REPORT A 55-year-old female patient presented in emergency care with severe chest tightness and shortness of breath. Initial ECG showed sinus rhythm, a heart rate of 84/minute and no ST-segment changes. She was treated symptomatically and placed under observation. A follow-up ECG revealed biphasic, inverted T waves in precordial leads V2-V5, consistent with Wellens Type A. Coronary angiography demonstrated moderate (40%) diffuse narrowing of the proximal LAD, which was potentially functionally significant given the patient's symptoms and ECG findings, as well as mild subocclusion of diagonal branches 1 and 2. The left circumflex artery had 50% stenosis. Obtuse marginal branch 2 had 50% stenosis. The right coronary artery showed significant (70%) mid-segment stenosis. These findings indicate that Wellens-type ECG changes may occur in the setting of multi-vessel coronary artery disease and are not always linked to a single critical LAD lesion. CONCLUSIONS Early Wellens syndrome recognition is crucial as this syndrome can lead to myocardial infarction. All patients with chest pain should be closely monitored with ECGs during pain episodes and pain-free intervals, and angiographic findings should be interpreted in the context of possible multi-vessel disease.
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