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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 4, July/August 2019

e2

AFRICA

described as biphasic T waves in V2–V3, which was the finding

in our patient (Fig. 1B). The more common type 2 Wellens’

accounts for the remaining 76% of cases and is identified by

deep, symmetrically inverted T waves in V1–V4. This T-wave

pattern is well recognised by junior doctors. It is important to

emphasise that the T-wave changes of Wellens’ syndrome occur

during pain-free periods, while during an episode of chest pain,

the T waves normalise.

The criteria for Wellens’ syndrome are as follows: previous

history of chest pain, no Q waves or loss of R waves, no

significant ST-segment elevation, normal or minimally elevated

cardiac markers, and biphasic/inverted T-wave changes in the

precordial leads. Without prompt diagnosis and aggressive

intervention, patients with Wellens’ syndrome may rapidly go

on to develop extensive anterior wall myocardial infarction,

with a mean time of 8.5 days. As a result, patients with Wellens’

syndrome should undergo immediate or rapid invasive coronary

strategy.

7

Conclusion

We highlight three learning points about this case: (1) immediate

repetitive ECG evaluation after the chest pain subsides, even

in young patients without significant risk factors; (2) timely

recognition of the diagnostic ECG pattern of Wellens’ syndrome;

(3) emergency coronary angiography should be conducted if

diagnosed.

References

1.

Coutinho Cruz M, Luiz I, Ferreira L, Cruz Ferreira R. Wellens’

syndrome: A bad omen.

Cardiology

2017;

137

(2): 100–103.

Fig. 1.

A. ECG obtained during onset of pain, showing no obvious T-wave changes. B. Pain-free ECG was then performed, which

showed biphasic T waves in leads V2–V4.

A

B

Fig. 2.

A. After coronary angiography, 95% stenosis of the proximal left anterior descending coronary artery was seen. B. After the

stenosis was treated with a drug-eluting stent.

A

B