Sedhai Yub Raj, Basnyat Soney, Bhattacharya Priyanka T
Internal Medicine, VCU School of Medicine, Richmond, Virginia, USA.
Internal Medicine, St. Mary Mercy Hospital, Livonia, Michigan, USA.
BMJ Case Rep. 2018 Dec 19;11(1):e227464. doi: 10.1136/bcr-2018-227464.
Wellens' syndrome is described as characteristic biphasic or symmetrical T-wave inversion with normal precordial R-wave progression and the absence of Q waves in the right precordial leads. It is seen during chest pain-free interval in a subset of patients with unstable angina. Wellens' syndrome is associated with critical stenosis of proximal left anterior descending (LAD) coronary artery. Similar characteristic ECG changes associated with causes other than LAD stenosis have been described as pseudo-Wellens' syndrome. In this case report, we present a young 22-year-old man who presented with characteristic Wellens' ECG changes in the setting of pulmonary embolism with right ventricular strain. T-wave inversion in right precordial leads is a well-recognised ECG manifestation of right ventricular strain; however, biphasic T waves in the setting of pulmonary embolism are rare. Pulmonary embolism was seen in our patient a week after starting risperidone. There is a reported association between antipsychotic drugs and increased risk of thromboembolism. Risperidone could have potentially contributed to the pulmonary embolism in our patient given the temporal association and absence of risk factors.
Wellens综合征被描述为具有特征性的双相或对称性T波倒置，胸前导联R波进展正常，右胸前导联无Q波。它见于不稳定型心绞痛患者的胸痛间期。Wellens综合征与左前降支（LAD）近端冠状动脉严重狭窄有关。与LAD狭窄以外的原因相关的类似特征性心电图改变被描述为假性Wellens综合征。在本病例报告中，我们介绍了一名22岁的年轻男性，他在患有右心室劳损的肺栓塞情况下出现了特征性的Wellens心电图改变。右胸前导联T波倒置是右心室劳损公认的心电图表现；然而，在肺栓塞情况下出现双相T波很少见。我们的患者在开始使用利培酮一周后出现了肺栓塞。有报道称抗精神病药物与血栓栓塞风险增加有关。鉴于时间上的关联且无危险因素，利培酮可能是导致我们患者发生肺栓塞的原因。
