Wellens Syndrome Case Study

A 52 year old male presented with epigastric pain, continuing in the emergency department. He has a history of hypertension, and is on Amlodipine. Thinking that epigastric pain might be an anginal equivalent, the following ECG was recorded:
ECG shows LVH. There are prominent Biphasic T waves in lateral precordial leads,V3-6.

The Emergency Residents were worried about Wellens' syndrome and treated for ACS. He was placed on a nitroglycerine drip and Heparin. Initial troponin was negative. Two followup serial ECGs done 3 hours later also showed up the same Electrocardiographic findings.
All troponins were normal. A formal echo showed concentric LVH and there was not even a subtle regional wall motion abnormality on echocardiogram suspicious for LAD distribution ischemia. Later, he also underwent a coronary angiogram which was completely normal.
1. Wellens' syndrome represents Electrocardiographic Biphasic T waves in anterior chest leads ,usually V2-4 with a terminal T wave negativity.
2. It is a sign of sub-total critical occlusion of proximal LAD and the patient is angina free during ECG