P174 WELLENS' SYNDROME: A TYPICAL CASE. (18th May 2022)

• Record Type: Journal Article
• Authors: Dell'Como, M; Bier, N; Carreras, G; Lazzari, L; Dominioni, I; Nicolì, L; Dominici, M
• Is Part Of: European heart journal supplements. Volume 24(2022)Supplement C
• Publication Date: 2022-05-18
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/suac012.166
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: 78–year–old man, hypertensive, diabetic, dyslipidemic, with a recent diagnosis of chronic ischemic encephalopathy and cognitive impairment that severely limited the acquisition of both proximate and remote pathological anamnesis.Transported to the emergency room from 118, contacted by family members, due to pain in the left arm associated with cold sweating and general malaise, symptoms lasting about 4 hours and no longer present upon arrival in the emergency room.On the Echocardiogram performed in ER: akinesia of the apex in its entirety and of the middle anterior wall, not present in a previous examination in April. To laboratory tests: first determination of the high sensitivity troponin within the limits of the norm. On ECG: sinus rhythm at 96 bpm, PR interval 144 ms, left axial deviation, elevation of the ST tract. at J point <1 mm with presence of biphasic T waves in V2–V3. QTc Bazett 409 ms.The patient was then taken to the hemodynamics room and subjected to angioplasty on the proximal anterior descending artery, for critical stenosis of the same. The case is a typical example of Wellens' Syndrome.It represents an electrocardiographic manifestation of critical stenosis of the proximal anterior interventricular artery in patients with unstable angina, which is associated with a high risk of developing extensive anterior infarction with a severe prognosis.Originally classified as two separate types, today it is considered as the evolution of type 1 into type 2, manifesting initially with biphasic inversions of the T wave (observed only in 25% of patients with Wellens) and, subsequently, with symmetrical inversions, often deep (> 2 mm) of the T wave, in the anterior precordials.This electrocardiographic aspect is typically present in the absence of pain, while the electrocardiographic trace generally normalizes in presence of pain.After coronary revascularization, most patients show normalization of the electrocardiogram and often of sectoral abnormalities of left ventricular function, suggesting that underlying the electrocardiographic and echocardiographic changes observed in Wellens is a mechanism of myocardial hibernation or stunning.