Tang Na, Li Yi-Hua, Kang Liang, Li Rong, Chu Qing-Min
The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China.
Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China.
World J Clin Cases. 2022 Jul 6;10(19):6672-6678. doi: 10.12998/wjcc.v10.i19.6672.
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.
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 T-wave 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 T-waves 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.
The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.
Wellens综合征是不稳定型心绞痛高危患者中出现的一种心电图模式。其特征为T波倒置或双向，在患者发生心绞痛发作时，胸前导联的T波会转变为正向或假性正常化波；然而，这种情况的机制仍不清楚。
一名47岁男性患者反复出现无诱因胸痛>20天，前一天病情加重。入院当天，他除了出现向左上肢放射痛和劳力性呼吸困难外，还经历了持续超过30分钟的阵发性胸痛发作。当时患者就诊于急诊科时无胸痛或其他不适。就诊时心电图显示窦性心动过速和T波改变，结合既往心电图结果诊断为Wellens综合征。心绞痛发作时心电图和心肌酶学检查正常，但心绞痛未发作时心电图显示T波倒置或双向。经皮冠状动脉介入治疗后，第0、1和2天心电图显示胸前导联T波倒置或双向，但第3天T波正常。后续心电图未显示缺血性ST-T波改变。
Wellens综合征的假性正常化T波可能反映不稳定型心绞痛发展为ST段抬高型心肌梗死的超急性期。
