Rare Case of Wellens syndrome progressing from type A to classic type B Wellens pattern: A report

"A very low threshold of suspicion and serial electrocardiograms (ECGs) were imperative to the early recognition of such a critical cardiovascular disease (CVD)," Mohammed J. Arisha, Charleston Area Medical Center/West Virginia University Charleston Division, Charleston, USA, and colleagues wrote stated in their case study.

Wellens syndrome is a well-known clinical syndrome with characteristics of specific ECG patterns usually suggestive of a critical proximal LAD (left anterior descending) coronary artery stenosis and needs early revascularization. The literature describes two Wellens ECG patterns (A and B). Studies showed that Wellens syndrome could evolve from pattern A into pattern B; however, a lack of reported cases described this phenomenon.

Pattern A is characterized by biphasic T waves, mainly in leads V2 and V3, and pattern B is characterized by diffuse deep T wave inversion in the precordial leads.

The case in question is of a 49-year-old female with a past medical history of hyperlipidemia, obesity, a family history of premature CVD, and tobacco use presented to the emergency department (ED) with the main complaint of intermittent, progressive, and exertional chest pain that radiated to her jaw, neck, and shoulders. The patient reported symptoms began approximately three days before the initial presentation at an outlying ED facility.

"Wellens syndrome is a well-established cardiovascular entity considered a pre-anterior myocardial infarction state," Arisha and the team wrote. They stressed the cruciality of early recognition of this syndrome, allowing proper management and avoiding potentially catastrophic outcomes, as it is usually associated with critical proximal LAD stenosis.

"Wellens syndrome can present with Wellens ECG pattern A and then progress to pattern B," they concluded. "This case report demonstrates that the shift from Wellens pattern A to pattern B can occur quickly."

Reference:

Arisha, M. J., Belcher, A., Annie, F., & Mian, M. S. (2023). Wellens syndrome progressing from a very subtle type a to a classic type B Wellens pattern. Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2023.05.009