Electrocardiographic signs of Wellens syndrome, such as biphasic T waves in leads V2-V3, are easily missed or misinterpreted, risking extensive anterior myocardial infarction.
This case highlights the importance of early detection of Wellens syndrome on ECG to prevent extensive anterior myocardial infarction, as biphasic T waves can be easily missed or misinterpreted.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Wellens syndrome is a pre-infarction state of coronary artery disease that indicates left anterior descending artery stenosis, inwhich biphasic or deeply inverted T waves in leads V2–3 may be seen on electrocardiogram. Patients are often pain-free at the time the electrocardiogram is recorded, increasing the risk of misinterpretation and delayed diagnosis. Failure to identify this high-risk electrocardiographic pattern may lead to rapid progression to extensive anterior myocardial infarction. Objective To describe a patient with Wellens syndrome that was initially missed on electrocardiogram, stress the importance of early detection to prevent the development of extensive anterior myocardial infarction, and raise clinician awareness of this high-risk electrocardiographic pattern. Case presentation A 54-year-old man was admitted with acute kidney injury, necessitating haemodialysis, diabetic ketoacidosis, and critical limb ischaemia, including gangrene in his right toe. He was initially diagnosed with type 2 myocardial infarction after he experienced chest pain and developed an increased troponin concentration. One week later, he developed another attack of diabetic ketoacidosis, and an electrocardiogram revealed a biphasic T wave, which was initially mistaken for T wave inversion. A repeat electrocardiogram the following day confirmed persistent biphasic T waves in leads V2-V3 consistent with Wellens syndrome. Coronary angiography proved difficult due to challenging radial access, and femoral access was declined. The patient was managed conservatively. Conclusion This patient’s clinical course highlights that the electrocardiographic signs of Wellens syndrome may be missed or misinterpreted. It also raises clinician awareness of this high-risk electrocardiographic pattern.
Areej Mustafa (Wed,) reported a other. Electrocardiographic signs of Wellens syndrome, such as biphasic T waves in leads V2-V3, are easily missed or misinterpreted, risking extensive anterior myocardial infarction.