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Wellens Syndrome or Inverted U Waves: A Serious Clinical Condition Needing Immediate Attention Regardless of Symptoms
- Source :
- The American Journal of Medicine. 134:1365-1367
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Abstrect Presentation : 76-year-old female with hypertension, diabetes, and end stage renal disease on hemodialysis was sent to the emergency department for complaining of neck and jaw pain associated with hypotension during dialysis. Her electrocardiogram is shown in figure 1. Clearly, biphasic T waves can be seen in V2-V3. These T wave changes were not seen in her last EKG. (figure 2). She was asymptomatic in the emergency department and her troponins were negative. Her electrolytes were also within normal limits with normal vital signs. Her cardiovascular exam was unremarkable. Assessment : The patient remained asymptomatic in the emergency room with persistent negative troponins. However, the appearance of pericardial biphasic T waves in V2 and V3 seen on her presenting EKG was consistent with Type A Wellen's syndrome EKG (or initially described by Dr. Gerson as inverted U waves). Even though, she had no chest pain and was hemodynamically stable, the classic appearance of Wellen's syndrome EKG is of major concern needing immediate diagnosis and treatment. Diagnosis : Patients presenting with Wellen's syndrome EKGs are at a very high risk for anterior myocardial infarction requiring an invasive work up regardless of their hemodynamic stability or level of cardiac enzymes. They have usually high-grade proximal left anterior descending or left main coronary artery disease. Management : As she was at a very high risk for myocardial infarction based on her EKG, she was taken to the cardiac catheterization laboratory despite remaining asymptomatic in the emergency department and having normal cardiac enzymes. Her coronary angiogram showed severe three vessel coronary artery disease with involvement of her proximal left anterior descending artery as suspected (figure 3). She underwent successful coronary artery bypass grafting. After her surgery, she did well and did not experience any further episodes of hypotension or jaw pain during her dialysis.
- Subjects :
- medicine.medical_specialty
Acute coronary syndrome
medicine.medical_treatment
Wellens' syndrome
Pain
030204 cardiovascular system & hematology
Coronary Angiography
Chest pain
Asymptomatic
End stage renal disease
Diabetes Complications
Coronary artery disease
Electrocardiography
03 medical and health sciences
0302 clinical medicine
Renal Dialysis
Internal medicine
Diabetes Mellitus
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Coronary Artery Bypass
Aged
Cardiac catheterization
business.industry
Coronary Stenosis
General Medicine
medicine.disease
Jaw
Hypertension
Cardiology
Kidney Failure, Chronic
Female
Hypotension
medicine.symptom
business
Subjects
Details
- ISSN :
- 00029343
- Volume :
- 134
- Database :
- OpenAIRE
- Journal :
- The American Journal of Medicine
- Accession number :
- edsair.doi.dedup.....6850b12ffc5accc2dc662c9a5ddf1c6f