CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Wellen's Syndrome: The Widow Maker - A Pre-infarction State of Coronary Artery Disease
Tanveer Iqbal Penwala1, Nay Thu Win1, Jayakhanthan Kolanthaivelu1
National Heart Institute, Malaysia1,
69-year-old gentlemen, non-smoker with underlying hypertension with no prior history of IHD presented with intermittent central chest pain for 1 week which worsen on the day of presentation. It was associated with diaphoresis and palpitation. BP was stable. Lungs were clear. No audible murmur heard on cardiovascular examination.
Trop I was elevated on presentation. Patient was admitted with diagnosis of NSTEMI. However, Trop I was further elevated on Day 2 of admission 1159 to 40413. ECG on day 2 showed evolving change biphasic T wave in V2 and V3, a characteristic finding of Wellen's syndrome.
Wellen's syndrome has a characteristic ECG pattern, particularly deep inverted or biphasic T waves in V2 -V3. This syndrome represents a pre-infarction state for coronary artery. It is highly specific for critical stenosis of proximal LAD. This sinister nature of this lesion is why it is also called a widow maker. Patients with these patterns of ECG are at high risk for extensive anterior myocardial infarction. If seen in a non-PCI hospital, it should prompt immediate cardiologist consultation. The definite treatment for this condition is procedural and not medical. Timely referral and procedure are needed to reduce the mortality in these patients.