WELLENS SYNDROME - REPORT OF TWO CASES IN A PATIENT WITH MULTIVESSEL CORONARY ARTERY DISEASE

Abstract

Acute coronary syndrome is a leading cause of death and increased morbidity in developed countries.Wellens syndrome as a high-risk of acute coronary syndrome is characterized by changes in the ST-T segment in theprecordial leads, indicating critical stenosis of the left anterior descending artery (LAD). This syndrome belongs tothe subgroup of patients with unstable angina pectoris who have inverted T waves in the anterior precordial leads onthe electrocardiogram (ECG). In our paper, we presented two cases of Wellens syndrome with critical LAD stenosis,performed coronary angiography and LAD stent placement. Wellens' syndrome can be a marker of critical LADstenosis in both its proximal and midsection. Changes can be temporary, last for months or disappear afterrevascularization treatment. Coronary angiography of the patient may also reveal critical stenosis of RCA (80%),LCx (100%), and diagonal-1 (90%). Failure to recognize this syndrome can cause a delay in referring patients forurgent coronary angiography and revascularization therapy that can lead to anterior myocardial infarction,significant left ventricular dysfunction, and even death. About 75% of patients with Wellens syndrome treated withconservative management alone will develop an extensive anterior myocardial infarction within a few days, with anaverage of 8.5 days from the onset of symptoms. This case study concludes that clinicians should be aware of ECGchanges in Wellens syndrome, which may occur during the pain-free period. For the definitive management ofWellens syndrome, the treatment of choice is cardiac catheterization with percutaneous coronary intervention (PCI),to relieve the patient of the symptoms of Wellens syndrome, as well as a number of complications of this acutecondition.