C82. Rare electrocardiography findings of Wellen’s Type A evolving into Type B on late onset Myocardial Infarction: A Case Report

Abstract

Abstract Background Wellens' Syndrome is a left anterior descending (LAD) coronary artery disease which first described in 1982 by de Zwaan et al. A byphasic T or deeply inverted T are the typical Wellen's electrocardiogram (ECG) changes which represent a critical stenosis. It may be presented without any typical symptoms, and normal or mildly elevated enzymes depends on its onset. Case Summary A 56-years-old male, admitted to ER with typical chest pain within 1 day. The first ECG showed byphasic T wave on V2 and V3, and an hour serial ECG showed a deeply inverted T wave on V2 and V3. Cardiac marker showed an elevated Troponin I levels of 1,590.6 ng/L. The patient was diagnosed with acute NSTEMI and underwent an early invasive strategy on the next day. Coronary angiography revealed total occlusion of the proximal LAD, and implantation of drug eluting stent was done accordingly. The patient remained symptoms-free after the procedure and discharged in stable condition. Discussion This patient suffering a left coronary total occlusion with no appearance of any ST-elevation on ECG. Therefore, a critical stenosis does not always came up with a typical ST-segment changes. Wellen’s type ECG showed how the T waves evolution would represent a critical stenosis. Early recognition of Wellen's typical ECG in this patient lead to early invasive strategy decision and later resulted a good outcome.