Wellens' Syndrome: A Critical ECG Pattern Signaling Impending Left Anterior Descending Coronary Artery Infarction

Wellens' syndrome is an underrecognized electrocardiogram (ECG) pattern that indicates critical stenosis of the left anterior descending (LAD) artery and impending myocardial infarction (MI). Unlike other acute coronary syndromes, it often presents without ST-segment elevation or substantial biomarker elevation. In patients with a recent history of chest pain, these ECG findings represent a preinfarction state requiring urgent coronary angiography. The authors have presented 2 cases demonstrating classic Wellens' patterns. The first patient had type A Wellens' syndrome, seen as biphasic T-waves in V2-V3. The second patient had type B Wellens' syndrome, characterized by deep symmetric T-wave inversions in the precordial leads V1-V6. Both patients had coronary angiography revealing critical mid-left anterior descending artery stenosis followed by successful percutaneous coronary intervention with drug-eluting stent placement. These cases highlighted the importance of recognizing non-ST-segment elevation ECG patterns that indicated critical coronary artery disease. Early recognition of Wellens' syndrome is essential, as medical management alone may not prevent progression to MI. Stress testing a patient with Wellens' syndrome may precipitate an extensive anterior MI.