Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos

Wellens’ syndrome (WS), also known as T-wave syndrome, refers to a specific T-wave abnormalities in the anterior chest leads that reflects a critical obstruction in the proximal left anterior descending (LAD) coronary artery. It is estimated that this syndrome concerns about 10-15% of all acute coronary syndromes (ACS). WS diagnostic criteria are a history of angina; minimal or no elevation of cardiac enzymes; minimal or no ST-segment elevation (<1 mm); no pathological precordial Q waves; biphasic T waves in leads V2 and V3 (WS type 1) or deep, symmetrical and inverted T waves in leads V2 and V3, and sometimes also in V1, V4, V5, and V6 (WS type 2). The mechanism behind these eletrocardiographic patterns is still unknown, but it is postulated that changes are due to the reperfusion of the ischemic myocardium due to alleviation of spasm of proximal LAD artery. Those electrocardiographic findings could be the only indication of an imminent anterior infarction, even in asymptomatic patients without prior history of chest pain. Without proper therapeutic approach, people with WS can rapidly progress to an anterior myocardial wall infarction (estimated incidence of 75%).
We present a case of a 52-year-old man who presented at emergency service with recurrent episodes of angina for the last two weeks. Physical examination was unremarkable. Electrocardiographic study showed a WS type 1 pattern. High-sensitivity troponin study revealed low values of 59, 76 and 119 ng/L respectively at admission, 3 hours and 6 hours after admission (reference value < 34,2ng/L). A WS was admitted. A charge dose of dual antiplatelet therapy was administered and an early coronary angiography was performed, revealing a critical proximal left anterior descending coronary artery occlusion of 90%. A drug-eluting stent was implanted. There was no recurrence of symptoms, the electrocardiographic findings solved and the patient was discharged two days later under dual antiplatelet therapy.