Key result
Painless syncope with Type B Wellens sign indicates pathognomonic LAD obstruction.
Case Report (n=1)
Wellens syndrome can present atypically with syncope and characteristic ECG changes even in the absence of chest pain and with low cardiac biomarkers.
Caution needed interpreting Wellens sign without pain or troponin rise; leaves open noncoronary causes including perimyocarditis in syncope.
Characteristic ST- and T-wave changes in the precordial electrocardiogram leads may indicate acute coronary syndrome, cardiomyopathies, channelopathies, catecholamine surge states, or perimyocarditis. This case presented involves a man who presented after sudden loss of consciousness. The patient's electrocardiogram was concerning for Type B Wellens sign, and cardiac biomarkers were low. Coronary artery occlusion was considered despite an absence of chest pain and the presence of left ventricular hypertrophy. Cardiac testing revealed pathognomonic obstruction of the left anterior descending artery associated with Wellens syndrome.
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John Ramos (2026) conducted a case report in Wellens syndrome (n=1). A male patient presenting with syncope and Type B Wellens sign without chest pain was found to have pathognomonic obstruction of the left anterior descending artery.
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