WELLENS SYNDROME - REPORT OF TWO CASES IN A PATIENT WITH MULTIVESSEL CORONARY ARTERY DISEASE
DOI:
https://doi.org/10.35120/kij5404619nKeywords:
acute coronary syndrome, wellens syndrome, left anterior descending artery, inverted t waves, revascularizationAbstract
Acute coronary syndrome is a leading cause of death and increased morbidity in developed countries.
Wellens syndrome as a high-risk of acute coronary syndrome is characterized by changes in the ST-T segment in the
precordial leads, indicating critical stenosis of the left anterior descending artery (LAD). This syndrome belongs to
the subgroup of patients with unstable angina pectoris who have inverted T waves in the anterior precordial leads on
the electrocardiogram (ECG). In our paper, we presented two cases of Wellens syndrome with critical LAD stenosis,
performed coronary angiography and LAD stent placement. Wellens' syndrome can be a marker of critical LAD
stenosis in both its proximal and midsection. Changes can be temporary, last for months or disappear after
revascularization treatment. Coronary angiography of the patient may also reveal critical stenosis of RCA (80%),
LCx (100%), and diagonal-1 (90%). Failure to recognize this syndrome can cause a delay in referring patients for
urgent coronary angiography and revascularization therapy that can lead to anterior myocardial infarction,
significant left ventricular dysfunction, and even death. About 75% of patients with Wellens syndrome treated with
conservative management alone will develop an extensive anterior myocardial infarction within a few days, with an
average of 8.5 days from the onset of symptoms. This case study concludes that clinicians should be aware of ECG
changes in Wellens syndrome, which may occur during the pain-free period. For the definitive management of
Wellens syndrome, the treatment of choice is cardiac catheterization with percutaneous coronary intervention (PCI),
to relieve the patient of the symptoms of Wellens syndrome, as well as a number of complications of this acute
condition.
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