Wellens' Syndrome – Report of two cases

Serdar Ozdemir; Tuba Cimilli Ozturk; Yalman Eyinc; Ozge Ecmel Onur; Muhammed Keskin

doi:10.1016/j.tjem.2014.07.002

Serdar Ozdemir¹, Tuba Cimilli Ozturk¹, Yalman Eyinc¹, Ozge Ecmel Onur¹, Muhammed Keskin²

¹Fatih Sultan Mehmet Education and Research Hospital, Emergency Medicine Clinic, Istanbul, Turkey
²Dr. Siyami Ersek Chest & Cardiovascular Surgery Training & Research Hospital, Cardiology Clinic, Istanbul, Turkey

Keywords: Wellens' Syndrome; LAD occlusion; Wellens'; Acute MI

Abstract

Wellens' Syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending (LAD) artery stenosis. Diagnostic criteria of Wellens' Syndrome are history of chest pain, little or no cardiac enzyme elevation, little or no ST-segment elevation, no loss of precordial R waves, no pathologic precordial Q waves and typical T-wave changes. Urgent cardiac catheterization is vital to prevent myocardial necrosis. Here we are presenting two cases with Wellens' Syndrome who had been sent for catheterization before marked myocardial infarction developed.

The first case was 63 years old woman admitted to emergency room with a typical chest pain lasting for 7 h. Electrocardiography (ECG) revealed characteristic Type A Wellens' Syndrome. The second case was also a 64 years old female patient. She was admitted to emergency room with a chest pain lasting for 2 days. Type B Wellens' Syndrome was considered according to ECG and clinical findings. Emergency angiography revealed critical LAD occlusions which were resolved before marked MI occurred in both of the cases.

It is important for the emergency physicians, to recognize the typical ECG findings of Wellens' Syndrome, because these characteristic ECG findings are considered as a marker for critical LAD occlusions.