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


Myopericarditis, Wellens’ syndrome, coronary artery disease


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.



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

    How to cite:
    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.