ST-Elevation Myocardial Infarction after Pharmacologic Persantine Stress Test in a Patient with Wellens' Syndrome.

Kunal Patel,Jayanth Koneru,Fady Alattar,Fayez Shamoon

doi:10.1155/2014/530451

Abstract

Wellens' syndrome, also known as LAD coronary T-wave inversion syndrome, is a characteristic ECG pattern that highly suggests critical stenosis of the proximal left anterior descending (LAD) coronary artery. 75% of patients with this finding go on to develop acute anterior wall myocardial infarction within one week unless prevented by early intervention on the culprit lesion. Most instances of ST-elevation occurring during cardiac stress testing have been observed with exercise, with only seven cases reported in the literature with pharmacologic stress. We present a case of a patient with no known cardiac disease who presented with chest pain and an ECG consistent with Wellens' syndrome that developed an acute anterior wall ST-elevation myocardial infarction after pharmacologic stress test.

Highlights

Wellens’ syndrome typically presents with the characteristic ECG findings of biphasic T-waves or deep symmetrical Twave inversions in the precordial leads. This ECG finding usually occurs during a pain-free period and is highly suggestive of critical proximal left anterior descending (LAD) coronary artery stenosis
Given the significant number of patients that will go on to develop acute anterior wall myocardial infarctions, it is critical that all physicians recognize this classic ECG pattern and institute measures for the patient to undergo urgent coronary angiography and revascularization
The pain continued for 30 minutes until EMS arrived and improved after sublingual nitroglycerin and chewable aspirin 325 mg

Summary

Introduction

Wellens’ syndrome typically presents with the characteristic ECG findings of biphasic T-waves or deep symmetrical Twave inversions in the precordial leads (leads V1–V4). This ECG finding usually occurs during a pain-free period and is highly suggestive of critical proximal LAD coronary artery stenosis. Given the significant number of patients that will go on to develop acute anterior wall myocardial infarctions, it is critical that all physicians recognize this classic ECG pattern and institute measures for the patient to undergo urgent coronary angiography and revascularization. If left untreated, managed medically, or further risk-stratified by cardiac stress testing, the patient may develop an extensive myocardial infarction or sudden death

Case Presentation

Discussion

Findings

Conflict of Interests