Wellens’ Syndrome: An Atypical Localization After an Atypical Transient Left Bundle Branch Block Presentation

Abstract

Wellens’ syndrome is a clinical presentation with a particular pattern of electrocardiographic (ECG) T-wave changes associated with critical, proximal left anterior descending (LAD) coronary artery lesions. We report a case of a variant presentation of Wellens’ syndrome diagnosed after the resolution of a transient left bundle branch block (LBBB). The patient initially presented with acute coronary syndrome (ACS), which failed to be diagnosed despite LBBB presentation, but later became apparent after ECG converted to a Wellens’ type pattern. There are three major learning points from this case. First, Wellens’ syndrome can be difficult to recognize when presenting with an abnormal initial ECG-in our case it was only diagnosed after LBBB resolution. Second, Wellens’ syndrome can present with atypical localization of the offending lesion-our patient was ultimately identified to have a mid-LAD lesion. Third, there is no data in the literature regarding the time to T-wave recovery after revascularization of the LAD-our follow-up marks the timing at somewhere between 2 weeks and 4 months. J Med Cases. 2019;10(7): 193-197 doi: https://doi.org/10.14740/jmc3322