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Zhang X, Kou Y. From Wellens' syndrome to acute anterior myocardial infarction, what is required? Only time! J Int Med Res 2024; 52:3000605241285229. [PMID: 39324187 PMCID: PMC11437533 DOI: 10.1177/03000605241285229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
The hallmark of Wellens' syndrome is a distinct modification in the precordial T wave of the electrocardiogram (ECG), which usually indicates substantial stenosis of the proximal left anterior descending artery (LAD). Patients with Wellens' syndrome commonly do not exhibit any symptoms of chest pain. This current case report describes a male patient in his early 60s who presented with sporadic chest pain who was subsequently diagnosed with Wellens' syndrome-related electrocardiographic abnormalities. In the precordial leads V2-V5, an inverted symmetric T wave was visible on the asymptomatic ECG. The inverted symmetric T wave of the precordial lead V2-V5 reverted back to being upright when the chest pain started. A follow-up ECG performed before emergency surgery revealed ventricular premature beats and an increase of 0.1-0.5 mV in the ST segment of the precordial leads V1-V5. A drug-eluting stent was inserted after the patient's coronary angiography revealed proximal stenosis of the LAD. To prevent acute myocardial infarction, emergency physicians must identify the ECG signs of Wellens' syndrome and treat high-risk patients with revascularization as soon as feasible. Early recognition and proactive intervention are crucial, as they may help to alleviate adverse consequences.
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Affiliation(s)
- Xu Zhang
- The First Central Clinical School, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Yafen Kou
- Department of Ultrasound, Tianjin Huanhu Hospital, Tianjin, China
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Zhou L, Gong X, Chen H, Dong T, Cui HH, Li H. Characteristics of Wellens' Syndrome in the Current PCI Era: A Single-Center Retrospective Study. Emerg Med Int 2023; 2023:8865553. [PMID: 37008757 PMCID: PMC10065856 DOI: 10.1155/2023/8865553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/25/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023] Open
Abstract
Objectives The goal of this retrospective study was to reveal the prevalence, angiographic characteristics, clinical presentation, and long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) patients with Wellens' syndrome. Background Procedural results for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have improved in recent years. However, there is still a paucity of available clinical trial data for Wellens' syndrome even though it is a well-known high-risk ACS. Methods Among a total of 3528 patients with ACS who underwent angioplasty from 2017 to 2019 at the Cardiovascular Center of Beijing Friendship Hospital, 476 NSTEMI patients with culprit left anterior descending (LAD) vessels were enrolled in this study. According to electrocardiographic criteria of Wellens' syndrome, the patients were divided into a Wellens group (n = 138) and a non-Wellens group (n = 338). The primary endpoint was cardiac death; the secondary endpoints were main adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, cardiac death, heart failure, target lesion revascularization, recurrent myocardial infarction, and stroke. All of the medical and follow-up data were obtained from our institutional database. Results The incidence of Wellens' syndrome in all ACS patients was 5.7% (200 of 3528). Among the 200 patients with Wellens' syndrome, 138 had NSTEMI, for a proportion of 69%. There was a significant decrease in the percentage of preexisting coronary heart disease (CHD), prior myocardial infarction, and previous PCI (P < 0.05) in the Wellens group compared with the non-Wellens group. On coronary angiography, single-vessel lesions were more common in the Wellens group (11.6% vs. 5.3%, P=0.016), and almost all (97.1%) of these patients received drug-eluting stents. Notably, the Wellens group had a higher proportion of early PCI than the non-Wellens group (71% vs. 61.2%, P=0.044). At 24 months, there was no statistically significant difference in cardiac death (P=0.111) between the two groups, but the MACCEs were comparable (Wellens: 5.1% vs. non-Wellens: 13.3%, P=0.009). Age ≥65 years was the largest independent risk factor for adverse prognosis. Conclusions With early recognition and aggressive intervention, Wellens' syndrome is no longer a risk factor for adverse prognosis in patients with NSTEMI in the current PCI era.
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Affiliation(s)
- Li Zhou
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xuhe Gong
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Tianhui Dong
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - He-he Cui
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Tang N, Li YH, Kang L, Li R, Chu QM. Entire process of electrocardiogram recording of Wellens syndrome: A case report. World J Clin Cases 2022; 10:6672-6678. [PMID: 35979282 PMCID: PMC9294889 DOI: 10.12998/wjcc.v10.i19.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/19/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wellens syndrome is an electrocardiogram (ECG) pattern seen in high-risk patients with unstable angina pectoris. It is characterized by inverted or biphasic T-waves that change into positive or pseudo-normalized waves at precordial leads when the patient experiences an angina attack; however, the mechanism for this condition remains unclear.
CASE SUMMARY A 47-year-old male patient experienced repeated, unprovoked episodes of chest pain for > 20 d, with worsening during the previous day. On the day of admission, he experienced episodes of paroxysmal chest pain lasting more than 30 min, in addition to radiating pain to the left arm and exertional dyspnea. The patient presented to the emergency department with no chest pain or other discomfort at that time. ECG at presentation showed sinus tachycardia and T-wave changes, which were identified as Wellens syndrome when combined with previous ECG findings. ECGs and myocardial enzymology examinations were normal when angina was present, but the ECG showed inverted or biphasic T-waves when angina was absent. After percutaneous coronary intervention, the ECGs demonstrated inverted or biphasic T-waves in the anterior precordial leads on days 0, 1, and 2, but normal T-waves on day 3. The ECGs showed no subsequent ischemic ST-T-wave changes.
CONCLUSION The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.
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Affiliation(s)
- Na Tang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Yi-Hua Li
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Liang Kang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Rong Li
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Qing-Min Chu
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
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Ghumman GM, Yarlagadda S, Dogra R, Salman F. Deeply Inverted and Biphasic T-Waves of Wellens' Syndrome: A Characteristic Electrocardiographic Pattern Not To Forget. Cureus 2022; 14:e22130. [PMID: 35308768 PMCID: PMC8920814 DOI: 10.7759/cureus.22130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Wellens’ syndrome refers to specific electrocardiographic (ECG) abnormalities of deeply inverted T-waves in the precordial leads, mainly V1-V3, associated with critical stenosis of the proximal left anterior descending (LAD) coronary artery. Identifying this specific pattern on the electrocardiogram is important as emergent treatment can prevent life-threatening myocardial infarction. We present a case of Wellens’ syndrome that had a combination of inverted and biphasic T-waves patterns and where timely identification of the abnormal ECG pattern by the emergency physician and prompt intervention by the cardiology team prevented the development of myocardial infarction and hence permanent damage to the heart.
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Affiliation(s)
| | | | - Ratika Dogra
- Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA
| | - Fnu Salman
- Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA
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Wu DF, Wu YX, Deng JL. Electrocardiographic findings of Wellens syndrome due to coronary artery-pulmonary artery fistula. J Int Med Res 2020; 48:300060520911495. [PMID: 32357111 PMCID: PMC7218948 DOI: 10.1177/0300060520911495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and any of the four cardiac chambers, the large vessels, or other vascular structures. Wellens syndrome is an ST-segment elevation myocardial infarction equivalent. Although both Wellens syndrome and CAFs have been reported in the literature, they have rarely been reported in the same patient. We herein report a case clinically diagnosed as Wellens syndrome by electrocardiography (ECG) findings; coronary angiography subsequently showed a fistula originating from the left anterior descending artery and draining into the pulmonary artery. The ECG findings then returned to normal after the fistula had been closed by controlled-release coils. These events confirmed that the abnormal ECG findings of Wellens syndrome were due to the CAF.
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Affiliation(s)
- Dong-Feng Wu
- Department of Geriatric Cardiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yin-Xiong Wu
- Department of Geriatric Cardiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jin-Long Deng
- Department of Geriatric Cardiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Stankovic I, Janicijevic A, Dimic A, Stefanovic M, Vidakovic R, Putnikovic B, Neskovic AN. Mechanical dispersion is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Ann Med 2018; 50:128-138. [PMID: 28972811 DOI: 10.1080/07853890.2017.1387282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Bundle branch blocks (BBB)-related mechanical dyssynchrony and dispersion may improve patient selection for device therapy, but their effect on the natural history of this patient population is unknown. METHODS A total of 155 patients with LVEF ≤ 35% and BBB, not treated with device therapy, were included. Mechanical dyssynchrony was defined as the presence of either septal flash or apical rocking. Contraction duration was assessed as time interval from the electrocardiographic R-(Q-)wave to peak longitudinal strain in each of 17 left ventricular segments. Mechanical dispersion was defined as either the standard deviation of all time intervals (dispersionSD) or as the difference between the longest and shortest time intervals (dispersiondelta). Patients were followed for cardiac mortality during a median period of 33 months. RESULTS Mechanical dyssynchrony was not associated with survival. More pronounced mechanical dispersiondelta was found in patients with dyssynchrony than in those without. In the multivariate regression analysis, patients' functional class, diabetes mellitus and dispersiondelta were independently associated with mortality. CONCLUSIONS Mechanical dispersion, but not dyssynchrony, was independently associated with mortality and it may be useful for risk stratification of patients with heart failure (HF) and BBB. Key Messages Mechanical dispersion, measured by strain echocardiography, is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Mechanical dispersion may be useful for risk stratification of patients with heart failure and bundle branch blocks.
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Affiliation(s)
- Ivan Stankovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Aleksandra Janicijevic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Aleksandra Dimic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Milica Stefanovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Radosav Vidakovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Biljana Putnikovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
| | - Aleksandar N Neskovic
- a Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine , University of Belgrade , Belgrade , Serbia
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Kyaw K, Latt H, Aung SSM, Tun NM, Phoo WY, Yin HH. Atypical Presentation of Acute Coronary Syndrome and Importance of Wellens' Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:199-202. [PMID: 29467360 PMCID: PMC5829624 DOI: 10.12659/ajcr.907992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patient: Female, 74 Final Diagnosis: Acute coronary syndrome Symptoms: Throat pain Medication: — Clinical Procedure: Percutaneous coronary intervention Specialty: Cardiology
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Affiliation(s)
- Kyaw Kyaw
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA
| | - Htun Latt
- Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA
| | - Sammy San Myint Aung
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA
| | - Nay Min Tun
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA
| | - Wut-Yi Phoo
- Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA
| | - Htwe Htwe Yin
- Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA
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