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A Case Report of Wellens’ Syndrome: An Ominous Sign of Left Anterior Descending Artery Critical Stenosis and Impending Anterior Myocardial Infarction

Herick Alvenus Willim, Andini Agustyana, Dwisetyo Gusti Arilaksono, Nurnajmia Curie Proklamartina, Muhammad Furqon

Abstract

Background: Wellens’ syndrome is a potentially life-threatening condition, characterized by biphasic or deeply inverted T-waves changes in electrocardiographic (ECG) precordial leads, which associated with critical stenosis of left anterior descending (LAD) coronary artery and impending anterior myocardial infarction in patients presenting with unstable angina. This syndrome is an important sign for clinicians because delay in coronary angiography and revascularization may lead toanterior myo­cardial infarction, left ventricular dysfunction, and even death.

Case presentation: A 50-year-old woman came to emergency department in a hospital in Bontang, with new onset intermittent typical chest pain lasting since 3 days. She had history of hypertension without regular medication. Physical examination was in normal ranges. An ECG obtained during chest pain-free period showed Wellens’ type A with biphasic T waves in V2-V6 and preserved R-wave progression. Troponin T was slightly elevated. During observation, the ECG pattern changed from Wellens’ type A to Wellens’ type B with deep T-wave inversions in V2-V6 and preserved R-wave progression.

Results: The patient was initially treated with conservative treatment. On the next day, she was referred to percutaneous coronary intervention-capable hospital in Samarinda. Coronary angiography revealed 90% stenosis of mid LAD. A drug-eluting stent was successfully implanted with restoration of LAD flow. She was discharged on the following day in good condition with medication of dual antiplatelet therapy, angiotensin-converting enzyme inhibitor, beta-blocker, and statin.

Conclusion: Clinicians should be aware of the ECG changes in Wellens’ syndrome, which may occur during pain-free period. Early recognition is crucial to avoid the development of anterior myocardial infarction. Immediate coronary angiography and revascularization is needed.

Keywords: Wellens’ syndrome, critical stenosis, myocardial infarction

Correspondence: Herick Alvenus Willim. Dr. Agoesdjam General Public Hospital, Ketapang, West Kalimantan. Email: herick_alvenus@yahoo.co.id.

Indonesian Journal of Medicine (2020), 05(03): 246-252
https://doi.org/10.26911/theijmed.2020.05.03.10

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References

Abulaiti A, Aini R, Xu H, Song Z (2013). A special case of Wellens’ syndrome.J Cardiovasc Dis Res, 4(1): 51–54. doi: 10.1016/j.jcdr.2013.02.016.


Al-assaf O, Abdulghani M, Musa A, AlJallaf M (2019). Wellens' syndrome: the life-threatening diagnosis.Circulation, 140:1851–1852. doi: 10.1161/CIRCU-LATIONAHA.119.043780.


Arisha MJ, Hallak A, Khan A (2019). A rare presentation of a rare entity: Wellens' syndrome with subtle terminal T wave changes. Case Rep Emerg Med, 2019: 1582030. doi: 10.1155/2019/1582030.


Bandara HGWAPL, Weerakoon WMG, Je-gavanthan A, Jayasekara NMTC, Kogulan T, Kularatne A, Sirisena TS, et al. (2018). Echocardiographic and angiographic characteristics of pati-ents with Wellens’ syndrome who underwent percutaneous coronary interventions.

Int J Recent Sci Res, 9(6): 27655–27659. doi: 10.24327/IJRSR.


Cruz MC, Luiz I, Ferreira L, Ferreira RC (2017). Wellens’ syndrome: A bad omen. Cardiology, 137(2): 100–103. doi: 10.1159/000455911.


De Zwaan C, Bar FW, Wellens HJ (1982). Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 103: 730–736.

doi: 10.1016/0002-8703(82)90480-x


Karadzic M, Vuckovic-Filipovic J, Davidovic G, Iric-Cupic V, Tasic MP, Kovacevic Z (2012). The “widow maker” warning sign or wellens’ syndrome: a case report.Arch Bio l Sci, 64(2):733–738. doi: 10.2298/ABS1202733K


Kardesoglu E, Celik T, Cebeci BS, Cingoz-bay BY, Dincturk M, Demiralp E (2003). Wellens’ syndrome: a case report.J Int Med Res, 31:585–590. doi: 10.1177/147323000303100615.


Kyaw K, Latt H, Aung SSM, Tun NM, Phoo WY, Yin HH (2018). Atypical presen-tation of acute coronary syndrome and importance of Wellens’ syn-drome.Am J Case Rep, 19: 199–202. doi: 10.12659/AJCR.907992.


Mufti M, Joea R, Sobnosky S, Longtine J (2018). Wellens’ Syndrome: an aty-pical presentation of an already silent killer. J Med Cases, 9(6):173–176. doi: 10.14740/jmc3058e.


Oo SZMWH, Khalighi K, Kodali A, May C, Aung TT, Snyder R (2016). Omnious T-wave inversions: Wellens’ syn-drome revisited. J Community Hosp Intern Med Perspect, 6(4): 32011. doi: 10.3402/jchimp.v6.32011.


Pallangyo P, Bhalia S, Longopa G, Mwinyi-pembe K, Millinga J, Misidai N, Swai HJ, et al. (2020). A case of Wellens syndrome in a 30-year-old woman from Sub-Saharan Africa: a perplex-ing clinical entity with invaluable lessons. J Investig Med High

Impact Case Rep, 8: 1-6. doi: 10.1177/2324-709620918552.


Purwaningtyas N, Meriedlona N (2017). Wellens’ syndrome and impending anterior wall myocardial infarction: a case report.Med Rep Case Stud, 2(3). doi: 10.4172/2572-5130.1000145.


Ramires TG, Sant'Anna J, Pais J, Picarra BC (2018). Wellens’ syndrome: a pattern to remember.BMJ Case Rep. 2018: bcr2018224582. doi: 10.1136/-bcr-2018-224582.


Singh B, Singh Y, Singla V, Nanjappa MC (2013). Wellens’ syndrome: a classical electrocardiographic sign of impending myocardial infarction. BMJ Case Rep, 2013: bcr2012008513. doi: 10.1-136/bcr-2012-008513.


Wang X, Sun J, Feng Z, Gao Y, Sun C, Li G (2018). Two case reports of Wellens’ syndrome. J Int Med Res, 46(11): 4845–4851. doi: 10.1177/03000605-18800857.

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