Wellen's syndrome (ST-T variant-clinician's dilemma)

Wellen's syndrome is a preinfarction clinical entity which describes characteristic ECG pattern which suggests high degree proximal LAD stenosis that will soon result in an acute anterior wall MI if patient is not urgently catheterised and occlusion is opened. This case report discusses an elderly male without any cardiac history with no chest pain came with lower abdominal pain and diagnosed to have urinary bladder calculi and was referred to us for preoperative fitness for open cystolithotomy and ECG changes. His ECG showed deep T wave inversion in V1-V5 with upward slopping of ST segment in V2-V5 (wellen's pattern). He was then transferred under cardiology unit and urgent CAG done and it showed 90% stenosis in proximal LAD and successful PTCA was done with placement of 2 drug eluting stents.

The ‘widow maker’: Electrocardiogram features that should not be missed

Patients with Wellen’s syndrome often present with chest pain and found to have specific precordial T-wave changes on the electrocardiogram (ECG). They subsequently develop a large anterior wall myocardial infarction. These specific electrocardiographic abnormalities are associated with critical stenosis of the proximal left anterior descending coronary artery (LAD). This syndrome is often under-recognised and has fatal consequences; it is, therefore, also known as the widow maker. We highlight a case of a 39-year old gentleman who had a history of coronary artery disease and typical ECG characteristics of Wellen’s syndrome.