How Well Do We Know Wellens?

Wellens' syndrome is a pattern of electrocardiographic T-wave changes that is associated with critical left anterior descending artery (LAD) stenosis. This syndrome continues to be under-recognized by clinicians and carries a significant risk of mortality if not intervened timely. We describe the case of an elderly Chinese woman who initially presented to the outpatient clinic with atypical chest pain. A routine EKG obtained in the office was documented as non-ischemic and was sent for a dobutamine stress echocardiogram. Pretest two-dimensional (2D) echocardiogram demonstrated akinesis and aneurysmal deformity of the entire apical myocardium and upon review of the previous EKG, Type 1 Wellens' sign was noted prompting emergent coronary angiogram, which revealed critical LAD stenosis (99%). She underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents.