Syncope and Wellens Sign: A Case Report and Review of Precordial ST- and T-Wave Changes in the Emergency Department

Characteristic ST- and T-wave changes in the precordial electrocardiogram leads may indicate acute coronary syndrome, cardiomyopathies, channelopathies, catecholamine surge states, or perimyocarditis. This case presented involves a man who presented after sudden loss of consciousness. The patient's electrocardiogram was concerning for Type B Wellens sign, and cardiac biomarkers were low. Coronary artery occlusion was considered despite an absence of chest pain and the presence of left ventricular hypertrophy. Cardiac testing revealed pathognomonic obstruction of the left anterior descending artery associated with Wellens syndrome.