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Pseudo-Wellens Syndrome Caused by Myocardial Bridging
1New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA.
Background:
Wellens syndrome is a preinfarction electrocardiographic pattern classically associated with critical proximal left anterior descending artery stenosis. However, nonatherosclerotic conditions, including myocardial bridging, may mimic this pattern.
Case Summary:
A 58-year-old man presented with intermittent chest pain and Wellens T-wave changes in the anterior leads. High-sensitivity troponin T levels were normal. Coronary angiography revealed normal coronary arteries with a mid left anterior descending myocardial bridge and no fixed stenosis. Beta-blocker therapy was deferred owing to baseline bradycardia.
Discussion:
Myocardial bridging may produce a pseudo-Wellens pattern through dynamic systolic compression and transient ischemia.
Take-Home Message:
Recognition of this phenocopy is essential to avoid misdiagnosis and unnecessary intervention.
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