Wellens’ Syndrome

This clinical image report describes a 58-year-old man with coronary artery disease who presented with intermittent chest pain at rest. His initial pain-free electrocardiogram (ECG) revealed biphasic T waves in leads V1–V2 and inverted T waves in V2–V3, suggestive of Wellens’ syndrome—a preinfarction pattern linked to critical proximal left anterior descending (LAD) artery stenosis. Shortly after presentation, he developed recurrent chest pain, and a follow-up ECG showed ST-segment elevation in leads V1–V6, I, and aVL. Emergency coronary angiography confirmed complete LAD occlusion, and a stent was successfully placed. The case highlights the characteristic ECG evolution in Wellens’ syndrome: early biphasic or deeply inverted T waves during pain-free reperfusion followed by acute ischemic ST changes upon reocclusion. Prompt recognition and intervention are critical to prevent anterior myocardial infarction, given the unstable plaque physiology and rapid progression risk. The patient recovered well and was discharged following a cardiac rehabilitation program.

This clinical image report describes a 58-year-old man with coronary artery disease who presented with intermittent chest pain at rest. His initial pain-free electrocardiogram (ECG) revealed biphasic T waves in leads V1–V2 and inverted T waves in V2–V3, suggestive of Wellens’ syndrome—a preinfarction pattern linked to critical proximal left anterior descending (LAD) artery stenosis. Shortly after presentation, he developed recurrent chest pain, and a follow-up ECG showed ST-segment elevation in leads V1–V6, I, and aVL. Emergency coronary angiography confirmed complete LAD occlusion, and a stent was successfully placed. The case highlights the characteristic ECG evolution in Wellens’ syndrome: early biphasic or deeply inverted T waves during pain-free reperfusion followed by acute ischemic ST changes upon reocclusion. Prompt recognition and intervention are critical to prevent anterior myocardial infarction, given the unstable plaque physiology and rapid progression risk. The patient recovered well and was discharged following a cardiac rehabilitation program.