Key result
Severe coronary vasospasm can cause a pseudo-Wellens pattern mimicking critical LAD stenosis without obstructive CAD.
Why the study?
Wellens syndrome is specific for critical LAD stenosis, but pseudo-Wellens syndrome mimics this ECG pattern without LAD stenosis, often due to vasospasm, requiring differentiation for management.
Case Report (n=1)
This case highlights the need for a high index of suspicion for coronary vasospasm when a Wellens ECG pattern occurs without obstructive coronary artery disease.
Supports evaluating for vasospasm in Wellens-pattern ECGs without fixed stenosis; leaves open prevalence and management of pseudo-Wellens.
BACKGROUND: Wellens syndrome is an electrocardiogram (ECG) pattern characterized by biphasic (type A) or deeply inverted (type B) T waves in anterior leads because of critical left anterior descending artery (LAD) stenosis. Pseudo-Wellens is an ECG mimic of Wellens syndrome in which LAD stenosis is absent. CASE SUMMARY: A 65-year-old man presented with sudden-onset angina. ECG obtained while angina-free demonstrated a type B Wellens pattern; coronary angiography revealed nonobstructive coronary artery disease. Fifteen days later, he returned with recurrent angina and upright T waves. As the pain resolved, he developed a type A Wellens pattern. Coronary angiography revealed severe vasospasm in the proximal LAD. DISCUSSION: Wellens syndrome is highly specific for critical LAD stenosis, whereas pseudo-Wellens most often occurs because of vasospasm. Both increase the risk of acute myocardial infarction, and differentiation is critical for appropriate management. TAKE-HOME MESSAGE: This case highlights the need for a high index of suspicion for coronary vasospasm when a Wellens pattern occurs in the absence of coronary artery disease.
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Durham et al. (2026) conducted a case report in Pseudo-Wellens Syndrome (n=1). Coronary vasospasm was evaluated. Severe coronary vasospasm can cause a pseudo-Wellens ECG pattern mimicking critical left anterior descending artery stenosis in the absence of obstructive coronary artery disease.
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