The term Wellens syndrome should be extended to include inferior and posterior wall coronary artery disease: a case report

Figures

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  Fig. 1. ECG taken on arrival at the Emergency Department

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  Fig. 2. Follow-up ECG performed the next morning

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  Fig. 3. Panel A: Left anterior descending coronary artery angiography showed only wall irregularities with a preserved lumen. Panel B upper frames: 99% ostial stenosis of the dominant right coronary artery on the coronary angiogram. Panel B lower frames: coronary angiogram after the intervention

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  Fig. 4. Enlarged beats from the case, showing the Wellens pattern in the inferior leads: in Panel A, on the initial recording; in Panel B, on the control ECG taken the following day

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  Fig. 5. Schematic illustration of ECG changes in Wellens syndrome. Panel 1 shows ST elevation in precordial leads in the case of occlusion of the coronary artery supplying the anterior wall. With spontaneous reperfusion, ST elevation first regresses, and the T wave becomes biphasic, positive-negative, which is known as Wellens syndrome type A (A). This can later gradually develop into Wellens syndrome type B (B), characterised by deep, symmetrical T-wave inversion. In the event of coronary reocclusion, type B reverts to type A, and ST elevation reappears after ECG pseudonormalisation. Panel 2 shows a schematic view of the same phenomenon in the inferior leads when the coronary artery supplying the inferior wall is involved. Panel 3 shows a schematic view of the same process in the precordial leads when the coronary artery supplying the posterior wall is involved