Published online Sep 26, 2023. doi: 10.4330/wjc.v15.i9.462
Peer-review started: March 15, 2023
First decision: June 14, 2023
Revised: June 29, 2023
Accepted: August 17, 2023
Article in press: August 17, 2023
Published online: September 26, 2023
Processing time: 189 Days and 16.2 Hours
Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery (LAD) stenosis and characteristic electrocardiograph (ECG) patterns in pain free state. The abnormal ECG pattern is classified into type A (biphasic T waves) and type B (deeply inverted T waves), based on the T wave pattern seen in the pericodial chest leads.
We present the case of a 37-year-old male with history of type 1 diabetes mellitus (T1DM), gastroparesis, mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea, vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin. Noted to have fasting blood sugar 392 mg/dL. Admitted for diabetic gastroparesis. During the hospital course, the patient was asymptomatic and denied any chest pain. On admission, No ECG and troponin draws were performed. On day 2, the patient became hypoxic with oxygen saturation 80% on room air, intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis. Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin. Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.
This case highlights an exceptional manifestation of Wellen's syndrome, wherein the right coronary artery and circumflex artery display a remarkable 100% constriction, alongside a proximal LAD stenosis of 90%-95%. Notably, this occurrence transpired in a patient grappling with extensive complications arising from T1DM. Moreover, it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.
Core Tip: When a patient exhibits atypical symptoms preceding chest pain and displays distinct T wave abnormalities on the electrocardiogram, it is crucial to seek immediate cardiology intervention. This entails conducting emergent cardiac catheterization to evaluate the presence of proximal stenosis in the left anterior descending artery, or in rare instances, the right coronary artery and left circumflex artery. Such stenosis can lead to the development of ischemic cardiomyopathy if left untreated. Acting promptly and carefully monitoring the characteristic T wave patterns, alongside normal or minimally elevated cardiac biomarkers, contributes to improved mortality prognosis.