Cocaine-induced pseudo-Wellens' syndrome: a Wellens' phenocopy

Acute coronary syndrome versus cardiac memory: Unexpected cause of Pseudo-Wellens syndrome

Pseudo-Wellens Syndrome (PWS) refers to absence of severe obstructive lesion in the proximal segment of the left anterior descending (LAD) despite having clinical and electrocardiography (ECG) features similar to Wellens Syndrome (WS). In previous reports, PWS most commonly caused by illicit drug use, stress cardiomyopathy, or unknown etiologies In this report, we aimed to present our case in which we detected the development of "memory T wave" secondary to Paroxysmal Supraventricular Tachycardia (PSVT) episodes as an interesting cause of PWS that has not been reported before.

Wellens Syndrome: prevalence, risk factors and coronary angiographic variation. A cross-sectional study

BACKGROUND

Wellens syndrome complicates acute coronary syndrome and, if unmanaged, can lead to immanent myocardial infarction. This study aimed towards determining the prevalence of Wellens syndrome among acute coronary syndrome patients while focusing on both types and identifying the associated risk factors, then exploring the variation in affected coronary arteries within patients fulfilling Wellens syndrome criteria.

METHODS

Implementing a descriptive cross sectional hospital based observational study design, at Ahmed Gasim Teaching Hospital for Cardiac Surgery and Renal Transplantation in Khartoum North, Sudan, the study was conducted following using a non probability convenience sampling of patients fitting the inclusion criteria. Data was collected using closed ended structured questionnaires. Ethical clearance was obtained from relevant authorities. Statistical analysis was done using descriptive and comparative data analysis with the aid of the SPSS software, and STROBE guidelines were followed.

RESULTS

A total of 120 patients were included, 70 males and 50 females, majority in their fifth decade. 14 patients had no documented risk factors. 42.5% had STEMI, 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%), 55.6% of them were type A and 44.4% were type B. Most frequently encountered risk factor among Wellens syndrome patients was Diabetes (50%). Out of 16 Wellens syndrome patients who underwent coronary angiography, 50% had mid LAD involvement, most were type A; 25% had proximal LAD involvement and 25% had normal coronary angiography. There was some association between Wellens syndrome and NSTEMI, but no significant association with any specific risk factor.

CONCLUSION

Wellens syndrome complicates 15% of acute coronary syndrome patients with a 55.6% possibility of becoming type A, it can present even without a specific predisposing risk factor and coronary angiographic variation other than the proximal part of the LAD artery may occur, including multiple vessels involvement. This is a descriptive cross sectional study conducted at Ahmed Gasim Teaching Hospital in Sudan, to determine the prevalence and risk factors of Wellens syndrome. Data was collected using questionnaires and analyzed with the SPSS software. Out of 120 patients, 14 patients had no documented risk factors. 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%). The commonest risk factor among Wellens syndrome patients was Diabetes (50%). 50% of Wellens syndrome patients had mid LAD involvement. The study concluded that Wellens syndrome is not rare, it can present without specific risk factor and coronary angiographic variation other than the proximal LAD artery can occur.

Wellens Syndrome: An Atypical Presentation With Burning Chest and Epigastric Pain

Wellens syndrome is a pre-infarction stage due to the critical stenosis of the proximal left anterior descending artery. It is characterized by intermittent chest pain with classical ECG changes. The cardiac biomarker is within the normal limit or only slightly elevated in this condition. Early recognition and cardiac intervention are important to prevent adverse cardiac outcomes. We report this rare case of Wellens syndrome in a 70-year-old male with intermittent chest and epigastric pain associated with belching for five days. The patient presented characteristic T-wave changes, symmetric deeply inverted T-waves, in precordial leads (V2-V4). Cardiac biomarkers, including troponin, were negative. He underwent cardiac catheterization and found a clot in the proximal left anterior descending coronary artery, which required a catheter-directed thrombectomy and drug-eluting stent placement. It is important to recognize this condition early and referred on time from primary health centers to higher centers, especially in developing countries like the Maldives, since delays in transfer may lead to a serious outcome.

Pseudo-Wellens syndrome from sepsis-induced cardiomyopathy: a case report and review of the literature

BACKGROUND

Pseudo-Wellens syndrome is a rare entity characterized by the presence of electrocardiogram (ECG) changes of Wellens syndrome but without the stenosis of the left anterior descending (LAD) coronary artery. In previous reports, pseudo-Wellens syndrome most commonly resulted from recreational drug use or unidentified etiologies. We present a unique case of pseudo-Wellens syndrome due to sepsis-induced cardiomyopathy and a review of the literature.

CASE PRESENTATION

A 62-year-old Caucasian woman was admitted for sepsis from left foot cellulitis. Laboratory data were notable for elevated lactate of 2.5 mmol/L and evidence of acute kidney injury. She developed chest pain on the third day of hospitalization. ECG showed symmetric T-wave inversion in leads V1-V4. Serial troponin I levels were within normal limits. Chest imaging showed no pulmonary embolism. Echocardiogram showed ejection fraction of 25%, left ventricular diastolic diameter of 4.6 cm, and multiple segmental wall motion abnormalities. Cardiac catheterization showed patent coronary arteries. The hospital course was complicated by transient sinus bradycardia and hypotension. She was hospitalized for a total of 17 days. ECG prior to discharge showed resolution of T-wave changes.

CONCLUSION

Pseudo-Wellens syndrome may result from myocardial ischemia due to vasospasm or myocardial edema from external insults. In our case, we suspect sepsis-related cytokine production resulting in cardiomyopathy and pseudo-Wellens syndrome. The clinical manifestations were indistinguishable between Wellens and pseudo-Wellens syndrome. Physicians should include the diagnosis of pseudo-Wellens syndrome when considering the presence of LAD coronary artery occlusion given risk stratifications.

Non-Atherosclerotic Myocardial Infarction With a Presentation of Wellens Syndrome

Myocardial infarction (MI) is a critical event that needs timely diagnosis and prompt management. Wellens syndrome can progress to MI if not managed in a timely manner. It implies the underlying critical stenosis of the left anterior descending (LAD) artery of the heart. In this report, we discuss an interesting presentation of pseudo-Wellens syndrome in a hypertensive middle-aged woman admitted as a case of Non-ST-elevation myocardial infarction (NSTEMI). During the hospital stay, she had an episode of chest pain with typical ECG changes, suggesting Wellens syndrome. However, upon intervening with coronary angiography, it turned out to be unremarkable for any coronary artery stenosis. She developed another episode of chest pain during her hospital stay with abnormal ECG patterns requiring further investigations with a non-invasive CT scan of coronary arteries and cardiac MRI for any infiltrative diseases. All workups were unremarkable. A multidisciplinary team involving the medical and interventional cardiology departments were involved in the diagnosis, and the patient was labeled as a case of vasospastic angina. She was treated with calcium channel blockers and was followed up as an outpatient for seven months with no further complications.

Our main objective was to highlight the interesting phenomenon of Wellens and pseudo-Wellens syndrome. The condition requires early diagnosis and timely management to make sure that no underlying critical pathology is present that can result in fatal complications like MI or cardiac arrest.

Pseudo-Wellens Syndrome in a Patient with Hypertension and Left Ventricular Hypertrophy

Patient: Male, 61

Final Diagnosis: Left ventricular hypertrophy

Symptoms: Chest pain

Medication: —

Clinical Procedure: Coronary angiography • echocardiogram

Specialty: Cardiology

Pseudo-Wellens' syndrome secondary to concurrent cannabis and phencyclidine intoxication

Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels. Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain. He was eventually diagnosed with pseudo-Wellens' syndrome. This paper illustrates that physicians should be vigilant for Wellens' syndrome mimicked by acute phencyclidine and cannabis intoxication. Additionally, we present a review of various aetiologies of pseudo-Wellens' syndrome, especially in patients with substance abuse.