Aborted myocardial infarction in a patient with rapid progression of Wellens syndrome

J Emerg Med. 2012 Sep;43(3):e181-4. doi: 10.1016/j.jemermed.2011.05.070. Epub 2011 Sep 25.

Abstract

Background: Wellens syndrome refers to a distinct electrocardiographic pattern of deeply inverted or biphasic T waves in the anterior precordial leads, in the presence of critical proximal stenosis of the left anterior descending coronary artery (LAD). The natural history of the syndrome is an extensive myocardial infarction within weeks of hospital admission.

Case report: This report describes a 63-year-old man in whom typical electrocardiographic signs of Wellens syndrome advanced to persistent ST-segment elevation within 7min of presentation. Extensive anterior myocardial infarction (AMI) was aborted by primary percutaneous coronary intervention of a sub-occluded proximal LAD.

Conclusion: Given the large area of the left ventricle supplied by a sub-occluded LAD, devastating AMI could have been expected and may have resulted in serious ventricular dysfunction and death. Therefore, early recognition of Wellens syndrome is essential and can be lifesaving.

Publication types

  • Case Reports

MeSH terms

  • Aspirin / therapeutic use
  • Clopidogrel
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / therapy
  • Early Diagnosis
  • Electrocardiography*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / etiology
  • Myocardial Infarction / therapy
  • Percutaneous Coronary Intervention
  • Platelet Aggregation Inhibitors / therapeutic use
  • Syndrome
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin