The Treacherous Inverted T-Wave: A Sign That Should Not Be Missed

Authors: Nazera Fazli, Deniz Dolun, Grecia Corrada, Sharmila Thiagarajan, Ugo Nwoko, Tioluwani Tolani

Cardiology Interest Group, American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten

Abstract:

Wellens Syndrome is an effective and essential indicator for a life-threatening Left Anterior Descending Coronary Artery (LAD) occlusion.1 On an Electrocardiogram (ECG), it appears as an inverted or biphasic T-wave in leads V2 and V3, which indicates a significant narrowing in the proximal LAD.2 This ECG finding carries great importance because it occurs in intervals of no chest pain, often with a history of angina.3 If left untreated or undertreated, Wellens syndrome has the potential to progress to a fatal myocardial infarction.1 Seventy-five percent of patients exhibiting Wellens Syndrome who did not receive cardiac catheterization beyond medicinal treatment proceeded to suffer myocardial infarctions.2 The objective of this project is to highlight the hazardous progression and complications of Wellens syndrome. In our case report, a 56-year-old female with a history of Stable Angina, hypothyroidism, and hypertension, presented to the Emergency Department with the complaint of squeezing substernal chest pain lasting 40 minutes, which later subsided. Her cardiac exam revealed a regular rhythm, with normal S1 and S2 sounds and no murmurs. Given the severity of this condition, serial ECGs were diagnostic in confirming Wellens Syndrome, as the condition manifests itself during the pain-free periods that are often overlooked.3 Patients exhibiting this ECG reading should be kept under supervision and immediately treated with angioplasty and even potentially coronary artery bypass graft surgery (CABG) because situations such as a stress test can increase the risk for sudden death.1,4 This case underlines the importance of the electrocardiograph for diagnosis and management of Wellens syndrome, with the intention of preventing potentially fatal complications.1

Bibliography: 

  1. Balasubramanian K, Balasubramanian R, Subramanian A. A dangerous twist of the ‘T’ wave: A case of Wellens’ Syndrome. Australas Med J. 2013;6(3):122-125. Published 2013 Mar 31. doi:10.4066/AMJ.2013.1636
  2. Miner B, Grigg WS, Hart EH. Wellens Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 25, 2020.
  3. Win Htut Oo SZ, Khalighi K, Kodali A, May C, Aung TT, Snyder R. Omnious T-wave inversions: Wellens’ syndrome revisited. J Community Hosp Intern Med Perspect. 2016;6(4):32011. Published 2016 Sep 7. doi:10.3402/jchimp.v6.32011 
  4. Yusuf Muharam M, Ahmad R, Harmy M. The ‘ widow maker’: Electrocardiogram features that should not be missed. Malays Fam Physician. 2013;8(1):45-47. Published 2013 Apr 30.

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