Wellens Syndrome with Syncope but Not Chest Pain

Omar Z. Yasin, Alberto Rubio-Tapia, Maurice E Sarano

Research output: Contribution to journalArticle

Abstract

We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for acute coronary syndrome, Wellens syndrome in particular, given the elevated troponin levels, lack of ST segment changes, and characteristic T-wave findings. The diagnosis was confirmed with angiography that showed a critical left anterior descending (LAD) artery occlusion. Since myocardial infarction does not typically present with syncope, we explored the differential diagnoses for T-wave inversions, which include electrolyte abnormalities, medications, intracranial hemorrhage, pulmonary embolism, and other cardiac diseases that were ruled out in our patient. We also explored the pathophysiology leading to syncope in the setting of acute myocardial infarction including arrhythmias and exaggerated neurally mediated response. Our patient received two drug-eluting stents to the LAD artery and was started on dual antiplatelet therapy, beta-blockers, and an angiotensin-converting enzyme inhibitor.

Original languageEnglish (US)
Pages (from-to)9-13
Number of pages5
JournalCardiology
DOIs
StateAccepted/In press - Dec 13 2016

Fingerprint

Syncope
Chest Pain
Arteries
Myocardial Infarction
Troponin
Drug-Eluting Stents
Intracranial Hemorrhages
Acute Coronary Syndrome
Pulmonary Embolism
Angiotensin-Converting Enzyme Inhibitors
Electrolytes
Hospital Emergency Service
Cardiac Arrhythmias
Heart Diseases
Angiography
Electrocardiography
Differential Diagnosis
Therapeutics

Keywords

  • Acute coronary syndromes
  • Acute myocardial infarction
  • Electrocardiogram
  • Syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Wellens Syndrome with Syncope but Not Chest Pain. / Yasin, Omar Z.; Rubio-Tapia, Alberto; Sarano, Maurice E.

In: Cardiology, 13.12.2016, p. 9-13.

Research output: Contribution to journalArticle

Yasin, Omar Z. ; Rubio-Tapia, Alberto ; Sarano, Maurice E. / Wellens Syndrome with Syncope but Not Chest Pain. In: Cardiology. 2016 ; pp. 9-13.
@article{f8f268c149064e37a197fe8d12f79edc,
title = "Wellens Syndrome with Syncope but Not Chest Pain",
abstract = "We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for acute coronary syndrome, Wellens syndrome in particular, given the elevated troponin levels, lack of ST segment changes, and characteristic T-wave findings. The diagnosis was confirmed with angiography that showed a critical left anterior descending (LAD) artery occlusion. Since myocardial infarction does not typically present with syncope, we explored the differential diagnoses for T-wave inversions, which include electrolyte abnormalities, medications, intracranial hemorrhage, pulmonary embolism, and other cardiac diseases that were ruled out in our patient. We also explored the pathophysiology leading to syncope in the setting of acute myocardial infarction including arrhythmias and exaggerated neurally mediated response. Our patient received two drug-eluting stents to the LAD artery and was started on dual antiplatelet therapy, beta-blockers, and an angiotensin-converting enzyme inhibitor.",
keywords = "Acute coronary syndromes, Acute myocardial infarction, Electrocardiogram, Syncope",
author = "Yasin, {Omar Z.} and Alberto Rubio-Tapia and Sarano, {Maurice E}",
year = "2016",
month = "12",
day = "13",
doi = "10.1159/000452707",
language = "English (US)",
pages = "9--13",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Wellens Syndrome with Syncope but Not Chest Pain

AU - Yasin, Omar Z.

AU - Rubio-Tapia, Alberto

AU - Sarano, Maurice E

PY - 2016/12/13

Y1 - 2016/12/13

N2 - We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for acute coronary syndrome, Wellens syndrome in particular, given the elevated troponin levels, lack of ST segment changes, and characteristic T-wave findings. The diagnosis was confirmed with angiography that showed a critical left anterior descending (LAD) artery occlusion. Since myocardial infarction does not typically present with syncope, we explored the differential diagnoses for T-wave inversions, which include electrolyte abnormalities, medications, intracranial hemorrhage, pulmonary embolism, and other cardiac diseases that were ruled out in our patient. We also explored the pathophysiology leading to syncope in the setting of acute myocardial infarction including arrhythmias and exaggerated neurally mediated response. Our patient received two drug-eluting stents to the LAD artery and was started on dual antiplatelet therapy, beta-blockers, and an angiotensin-converting enzyme inhibitor.

AB - We report the case of a woman in her 70s presenting to the emergency department with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for acute coronary syndrome, Wellens syndrome in particular, given the elevated troponin levels, lack of ST segment changes, and characteristic T-wave findings. The diagnosis was confirmed with angiography that showed a critical left anterior descending (LAD) artery occlusion. Since myocardial infarction does not typically present with syncope, we explored the differential diagnoses for T-wave inversions, which include electrolyte abnormalities, medications, intracranial hemorrhage, pulmonary embolism, and other cardiac diseases that were ruled out in our patient. We also explored the pathophysiology leading to syncope in the setting of acute myocardial infarction including arrhythmias and exaggerated neurally mediated response. Our patient received two drug-eluting stents to the LAD artery and was started on dual antiplatelet therapy, beta-blockers, and an angiotensin-converting enzyme inhibitor.

KW - Acute coronary syndromes

KW - Acute myocardial infarction

KW - Electrocardiogram

KW - Syncope

UR - http://www.scopus.com/inward/record.url?scp=85006262134&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006262134&partnerID=8YFLogxK

U2 - 10.1159/000452707

DO - 10.1159/000452707

M3 - Article

SP - 9

EP - 13

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

ER -