Left anterior descending coronary T-wave inversion pattern (Wellens’ syndrome) associated with myopericarditis and a normal left coronary artery
  • Geeta Bhagia
    Rochester General Hospital, Rochester, USA
  • Nasir Hussain
    UHS Wilson Medical Center, Johnson City, USA
  • Fnu Arty
    Monmouth Medical Center, Long Branch, USA
  • Victor Farah
    Allegheny General Hospital, Allegheny Health Network, Pittsburgh, USA
  • Robert Biederman
    Allegheny General Hospital, Allegheny Health Network, Pittsburgh, USA

Keywords

Myopericarditis, Wellens’ syndrome, coronary artery disease

Abstract

Background: Wellens’ syndrome is characterised by a history of chest pain with an abnormal electrocardiogram (EKG), demonstrating biphasic or deeply inverted T waves in leads V2–3 (may extend to involve all precordial and lateral limb leads – the type B Wellens’ pattern). A Wellens’ EKG pattern is considered highly specific for critical stenosis involving the ostial/proximal left anterior descending artery (LAD). However, there are no reported cases of an association of a Wellens’ EKG pattern with myopericarditis. Here, we present such a rare case.
Case description: A thirty-one-year-old female with known essential hypertension and psoriatic arthritis presented with a constant, central chest pain radiating to the shoulders and back. The patient’s physical examination was unremarkable at presentation other than elevated blood pressure at 170/68 mmHg. An EKG at presentation demonstrated deep symmetric T-wave inversions in anterolateral leads with elevated high-sensitivity troponin, and an elevated erythrocyte sedimentation rate. The patient was referred to the cardiac catheterisation laboratory for concerns of a Wellens’ EKG pattern; however, invasive angiography demonstrated only obtuse marginal branch disease – no LAD disease was noted. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis of myopericarditis and absence of myocardial infarction. The patient was medically managed and discharged home in a stable condition.
Conclusion: In literature and established clinical practice, the Wellens’ EKG pattern is considered highly concerning for critical ostial/proximal LAD stenosis. However, we now propose that myopericarditis may be considered in a differential diagnosis for this EKG pattern.

VIEW THE ENTIRE ARTICLE

References

  • de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982;103:730–736.
  • de Zwaan C, Bär FW, Janssen JH, Cheriex EC, Dassen WR, Brugada P, et al. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J 1989;117:657–665.
  • Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens’’ syndrome. Am J Emerg Med 2002;20:638–643.
  • Ju TR, Yeo I, Pontone G, Bhatt R. Pseudo-Wellens’ syndrome from sepsis-induced cardiomyopathy: a case report and review of the literature. J Med Case Rep 2021;15:151.
  • Imazio M, Trinchero R. Myopericarditis: etiology, management, and prognosis. Int J Cardiol 2008;127:17–26.
  • Hua A, O’Gallagher K, Sado D, Byrne J. Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19. Eur Heart J 2020;41:2130.
  • Ling RR, Ramanathan K, Tan FL, Tai BC, Somani J, Fisher D, et al. Myopericarditis following COVID-19 vaccination and non-COVID-19 vaccination: a systematic review and meta-analysis. Lancet Respir Med 2022;10:679–688.
  • O’Gallagher K, Kanyal R, Sado, D, Byrne J. ‘COVID-19 Myopericarditis’ American College of Cardiology 2020. Accessed 21 April 2022. Available from: https://www.acc.org/latest-in-cardiology/articles/2020/09/25/17/22/covid-19-myopericarditis
  • Sharma J, Fernandes N, Alvarez D, Khanna S. Acute myopericarditis in an adolescent mimicking acute myocardial infarction. Pediatr Emerg Care 2015;31:427–430.
  • Hussain A, Iqbal M, Mohsin G, Mirza HA, Butt MT. Bewildering ST-elevation with Wellens’’ electrocardiogram pattern – is myocarditis in your differentials? Cureus 2021;13:e12983.
  • Views: 139
    HTML downloads: 10
    PDF downloads: 79


    Published: 2024-05-13
    Issue: 2024: Vol 11 No 6 (view)


    How to cite:
    1.
    Bhagia G, Hussain N, Arty F, Farah V, Biederman R. Left anterior descending coronary T-wave inversion pattern (Wellens’ syndrome) associated with myopericarditis and a normal left coronary artery. EJCRIM 2024;11 doi:10.12890/2024_004525.