The Calm Before the Storm: Wellens Syndrome Revisited

Abstract

Wellens syndrome is a characteristic electrocardiographic pattern indicating a critical stenosis of the left anterior descending (LAD) coronary artery and is a warning sign for an impending anterior myocardial infarction. Early recognition is crucial, as this pattern typically appears when the patient is pain-free and cardiac biomarkers are standard, which can potentially mislead clinicians. This case report aims to highlight the importance of recognizing the pattern of Wellens Syndrome through the clinical description of patient Mr. A, a 61-year-old male with hypertension and chronic kidney disease who presented with chest pain that has subsided. We present a 61-year-old Melanesian man with a history of hypertension and stage 3 chronic kidney disease, who had recent anginal chest pain that resolved upon evaluation. On examination, blood pressure was 154/80 mmHg, heart rate 78/min, respiratory rate 20/min, temperature 36.7°C, oxygen saturation 99% on room air, and minimal pitting oedema in both legs. The ECG obtained showed biphasic T waves in leads V2–V4 with the patient feels no chest pain at all, consistent with a type A Wellens pattern. Troponin T was negative (< 40 ng/L), and no ST elevation or pathologic Q waves were observed. Chest X-ray showed cardiomegaly. Coronary angiography revealed a critical stenosis in the proximal LAD. The patient underwent percutaneous coronary intervention with stent placement to the proximal LAD. Wellens syndrome represents a “pre-infarction” state that should be identified to prompt urgent revascularization before extensive myocardial infarction occurs. This case underscores the importance of recognizing Wellens syndrome as “the calm before the storm” and avoiding conservative management that could lead to adverse outcomes.