Kyaw Kyaw, Latt Htun, Aung Sammy San Myint, Tun Nay Min, Phoo Wut-Yi, Yin Htwe Htwe
Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA.
Department of Internal Medicine, University of Nevada-Reno, School of Medicine, Reno, NV, USA.
Am J Case Rep. 2018 Feb 22;19:199-202. doi: 10.12659/ajcr.907992.
BACKGROUND Acute coronary syndrome (ACS) is a common and potentially life-threatening condition encountered in emergency departments. Despite its dreaded nature, nearly one-third of ACS present without chest pain and may mislead clinicians. Additionally, Wellens' syndrome is a pre-infarction stage of significant proximal left anterior descending (LAD) artery stenosis, which can lead to extensive anterior wall myocardial infarction without timely intervention. CASE REPORT We report the case of a 74-year-old woman presenting with isolated throat pain and Wellens' pattern in the initial EKG, which prompted the proper workup and management. Subsequently, coronary angiogram revealed more than 90% occlusion of the proximal LAD artery, and a drug-eluting stent was deployed. The patient did well after the procedure and the follow-up at 2 weeks after discharge was uneventful. CONCLUSIONS This case highlights the importance of awareness of atypical presentation of ACS and importance of Wellens' syndrome. We also discuss the incidence of craniofacial symptoms of ACS, and the epidemiology, pathophysiology, management, and prognosis of Wellens' syndrome.
背景 急性冠状动脉综合征（ACS）是急诊科常见的、可能危及生命的病症。尽管其性质可怕，但近三分之一的ACS患者并无胸痛症状，这可能会误导临床医生。此外，Wellens综合征是左前降支（LAD）近端严重狭窄的梗死前期，若不及时干预，可导致大面积前壁心肌梗死。 病例报告 我们报告一例74岁女性患者，最初心电图显示仅有咽痛及Wellens图形，这促使进行了恰当的检查和治疗。随后，冠状动脉造影显示LAD近端闭塞超过90%，遂植入药物洗脱支架。术后患者情况良好，出院后2周随访无异常。 结论 本病例突出了认识ACS非典型表现及Wellens综合征的重要性。我们还讨论了ACS颅面部症状的发生率以及Wellens综合征的流行病学、病理生理学、治疗及预后。
