Wellens' Syndrome Presenting as Epigastric Pain and Syncope: An Unusual Presentation.

Temitope Ajibawo,Sonu Sahni,Alexander Andreev

doi:10.7759/cureus.6877

Abstract

Wellens’ syndrome, also regarded as left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending artery (LAD) stenosis. It is characterized by deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads in a patient with unstable angina. Patients typically present with symptoms consistent with acute coronary syndrome. We present a unique case of Wellens’ syndrome with no angiographic findings of significant stenosis in the proximal LAD but with significant occlusion of the proximal circumflex artery and initial presentation with a chief complaint of epigastric pain and syncope. Physicians need to recognize these characteristic EKG changes during the pre-infarction stage, as they represent myocardial necrosis. Many of these patients eventually develop extensive anterior myocardial infarction with marked left ventricular dysfunction and death if coronary angiography and coronary revascularization are not performed within a few weeks. If Wellens’ is seen, patients should undergo urgent cardiac catheterization.

Highlights

Wellens’ syndrome, regarded as left anterior descending coronary T-wave syndrome, was first described by de Zwaan et al in the late 20th century, who recognized specific precordial T-wave changes in the setting of anticipant changes and, subsequently, anterior wall myocardial infarction (MI) in a subset of patients with unstable angina [1]
The typical presentation is that of unstable angina, which includes chest pain, which may be present at rest, chest tightness, and diaphoresis, along with other commonly seen symptoms of acute coronary syndrome
It is important to note that cardiac stress tests are contraindicated in these patients, as it delays the diagnosis of severe proximal left anterior descending (LAD) disease, and it can induce myocardial infarction in an already critically stenosed artery

Summary

Introduction

Wellens’ syndrome, regarded as left anterior descending coronary T-wave syndrome, was first described by de Zwaan et al in the late 20th century, who recognized specific precordial T-wave changes in the setting of anticipant changes and, subsequently, anterior wall myocardial infarction (MI) in a subset of patients with unstable angina [1]. Wellens’ syndrome criteria include deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads, i.e. V2 and V3 (may involve V1-V6), in a patient with unstable angina [2]. These T-wave changes on electrocardiogram (EKG) may persist for hours to days and are linked to a possible underlying obstruction in the proximal left anterior descending (LAD) coronary artery [2]. EKG on discharge, two days after stent placement is shown, and it demonstrates biphasic Twaves in leads V2, V3, and T-wave inversions in V4 and V5 He was discharged home on a high-intensity statin, beta-blocker, and dual antiplatelet therapy (aspirin and ticagrelor)

Discussion

Conclusions

Findings

Disclosures