Variant of Wellen’s syndrome in type 1 diabetic patient: A case report

BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.

Entire process of electrocardiogram recording of Wellens syndrome:A case report

BACKGROUND Wellens syndrome is an electrocardiogram(ECG)pattern seen in high-risk patients with unstable angina pectoris.It is characterized by inverted or biphasic T-waves that change into positive or pseudo-normalized waves at precordial leads when the patient experiences an angina attack;however,the mechanism for this condition remains unclear.CASE SUMMARY A 47-year-old male patient experienced repeated,unprovoked episodes of chest pain for>20 d,with worsening during the previous day.On the day of admission,he experienced episodes of paroxysmal chest pain lasting more than 30 min,in addition to radiating pain to the left arm and exertional dyspnea.The patient presented to the emergency department with no chest pain or other discomfort at that time.ECG at presentation showed sinus tachycardia and Twave changes,which were identified as Wellens syndrome when combined with previous ECG findings.ECGs and myocardial enzymology examinations were normal when angina was present,but the ECG showed inverted or biphasic Twaves when angina was absent.After percutaneous coronary intervention,the ECGs demonstrated inverted or biphasic T-waves in the anterior precordial leads on days 0,1,and 2,but normal T-waves on day 3.The ECGs showed no subsequent ischemic ST-T-wave changes.CONCLUSION The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.