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Her medical history was complicated with cerebral palsy, Wellens Syndrome is a medical zebra that is not familiar to
hypertension, hyperlipidemia, GERD, chronic low back Anteroseptal Fixed Defect LAD Critical Stenosis many physicians. The relatively subtle ECG findings with no
pain, and past CVA. She was a former 25 pack/year to little cardiac enzyme elevation mask a potentially
smoker, but denied any illicit drug use or alcohol dangerous and life-threatening syndrome.
consumption. On presentation, her vital signs were stable,
physical exam only remarkable for L-sided carotid bruit. As clinicians, it is of paramount importance to recognize
Auscultation of the heart did not reveal any murmurs, this syndrome because it represents a preinfarction stage of
rubs, or gallops. Lungs were clear bilaterally. There were coronary artery disease (CAD) that often progresses to
no lower extremity edema. extensive anterior wall MI and severe left ventricular
dysfunction. We must be able to identify simple, yet easy-to-
Further workup in the ER revealed an unremarkable CBC, miss ECG changes.
BMP and lipid panel. Initial cardiac troponins were
indeterminate <0.03, 0.04 and 0.05. Initial ECG revealed T-
wave inversions in V1-V3 and deep T waves in V4-5
without any ST segment changes. Patient was References
administered aspirin, nitroglycerin, morphine and admitted 1. de Zwaan C, Bar FW, Wellens HJ. Characteristic
to the hospital. electrocardiographic pattern indicating a critical stenosis
high in left anterior descending coronary artery in patients
A Lexiscan Myoview stress test was ordered and revealed admitted because of impending myocardial infarction. Am
an anteroseptal fixed defect with some mild apical septal Heart J. Apr 1982; 103 (4 Pt 2): 730-6.
reversibility with an estimated ejection fraction of 65%. 2. Mead N, O’ Keefe K. Wellens Syndrome: An ominous EKG
Apical and inferolateral hypokinesis were also noted. pattern. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3):206-8.
Acknowledgements 3. Tatli E, Aktoz M, Buyuklu M, Altun A. Wellens' syndrome:
In light of her worsening symptoms, the decision was We would like to thank the Swedish the electrocardiographic finding that is seen as unimportant.
made to undergo cardiac catheterization which Covenant Hospital faculty and staff for Cardiol J. 2009;16(1):73-5.
serendipitously found a 95% tubular stenosis in the their collaboration in this patient case. 4. Narasimhan S, Robinson GM. Wellens syndrome: a
proximal LAD. CABG was recommended and the patient Special consideration to Walter Baba MD, combined variant. J Postgrad Med. Jan-Mar 2004;50(1):73-4.
underwent successful coronary artery bypass grafting with PHD and Steve Attanasio, DO for their 5. de Zwaan C, Bar FW, Janssen JH, et al. Angiographic and
left internal mammary artery x 2. Postoperative, her contribution and case review in clinical characteristics of patients with unstable angina
clinical course was complicated with atrial fibrillation with preparation of this poster. showing an ECG pattern indicating critical narrowing of the
RVR and prolonged pauses in cardiac activity which proximal LAD coronary artery. Am Heart J. Mar
eventually prompted insertion of a pacemaker. 1989;117(3):657-65.