![]() ![]() These T-wave changes represent reperfusion of the myocardium. Wellen's syndrome is diagnosed based on the classic T-wave findings seen on an EKG taken when the patient is pain-free. It consists of a characteristic EKG finding suggesting severe stenosis of the proximal LAD artery, which will develop into an acute anterior wall MI within a few days to weeks in 75% of untreated patients. Wellen's syndrome was first described by Gerson and colleagues in 1980 as an inverted U-wave, and again in 1982 by De Zwaan, Wellens and colleagues as Wellen's syndrome. An echocardiogram estimated EF to be 60-65% and found no dysfunction. The left ventriculogram demonstrated normal left ventricular function with an ejection fraction (EF) of 55-60%. Two drug-eluting stents were deployed, one in the proximal LAD and the other in the D1. High-moderate disease was discovered in the mid-LAD, proximal left circumflex and ostial right coronary artery. He was found to have multivessel disease, with the proximal LAD artery severely stenosed with a 95% blockage. The patient was admitted to the CCU and taken to cardiac catheterization the next morning. Heparin was held as the patient's stool tested positive for occult blood. Aspirin 325 mg was administered, and the patient was started on a nitroglycerin drip. The patient was placed on oxygen via a nasal cannula as well as a cardiac monitor. ![]() Cardiac enzymes and lipid profile were obtained and found to be within normal limits. The EKG was immediately recognized as representing Wellen's syndrome. ĮKG suspicious for Wellen's syndrome with biphasic T-waves in V1 and V2 and deeply inverted T-waves in V3 and V4 The EKG obtained without pain being present showed normal sinus rhythm, normal axis, narrow QRS, no Q waves, isoelectric ST-segment, biphasic T waves in V1 and V2 and deep, inverted T waves in V3 and V4. There was no cardiomegaly, infiltrates, effusions or other abnormality seen on chest radiograph. The cardiovascular examination was normal, as was the remainder of the physical examination. Vital signs were: pulse 83, BP 125/80, T 36.6☌, RR 18/min, and saturation on room air was 99%. ![]() On physical examination, the patient was in no distress and was pain-free. His mother sustained an acute MI in her 50s. He denied any illicit drug use including cocaine. He did have a 22-pack-year smoking history, and reported occasional binge drinking. He also denied a history of hypertension, hyperlipidemia or arrhythmia. The patient denied any previous episodes of chest pain. The patient was pain-free when the EKG was accomplished. The most recent episode was immediately prior to his ED presentation. Two occurrences were associated with exertion, lasting for about 15 min and relieved by rest, while the other episode awoke him from sleep. ![]() One day prior to the ED visit, he experienced three episodes of this chest pain. There was no associated nausea, vomiting or back pain. Associated symptoms included profuse diaphoresis, dizziness, shortness of breath and palpitations. The pain was described as an intermittent pressure, 7 out of 10 in severity, located retrosternally and in the left parasternal region, and radiating down the left arm. A 37-year-old male presented to the emergency department (ED) for new onset of chest pain of 2 days duration. ![]()
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