Key result
A woman in her 70s presenting with syncope and characteristic ECG changes was diagnosed with Wellens syndrome and successfully treated with two drug-eluting stents to a critical LAD occlusion.
Case Report (n=1)
Wellens syndrome can present atypically with syncope instead of chest pain, highlighting the importance of recognizing characteristic ECG changes even in the absence of typical symptoms.
Syncope may indicate Wellens syndrome; this case leaves open whether ECG vigilance should expand beyond chest pain.
We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for acute coronary syndrome, Wellens syndrome in particular, given the elevated troponin levels, lack of ST segment changes, and characteristic T-wave findings. The diagnosis was confirmed with angiography that showed a critical left anterior descending (LAD) artery occlusion. Since myocardial infarction does not typically present with syncope, we explored the differential diagnoses for T-wave inversions, which include electrolyte abnormalities, medications, intracranial hemorrhage, pulmonary embolism, and other cardiac diseases that were ruled out in our patient. We also explored the pathophysiology leading to syncope in the setting of acute myocardial infarction including arrhythmias and exaggerated neurally mediated response. Our patient received two drug-eluting stents to the LAD artery and was started on dual antiplatelet therapy, beta-blockers, and an angiotensin-converting enzyme inhibitor.
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Yasin et al. (2016) conducted a case report in Wellens syndrome (n=1). Percutaneous coronary intervention (drug-eluting stents) was evaluated. A woman in her 70s presenting with syncope and characteristic ECG changes was diagnosed with Wellens syndrome and successfully treated with two drug-eluting stents to a critical LAD occlusion.
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