Clemente Giuseppe, Quaranta Cosimo, Basso Maria Grazia, Pintus Chiara, Rizzo Giuliana, Vullo Celeste, Bruno Silvia, Castro Francesca, Puccio Danilo, Nola Roberto, Novo Giuseppina, Corrado Egle, Tuttolomondo Antonino
Internal Medicine and Stroke Care Ward, University Hospital Policlinico P. Giaccone, 90127 Palermo, Italy.
Coronary Intensive Care Unit, University Hospital Policlinico P. Giaccone, 90127 Palermo, Italy.
Rev Cardiovasc Med. 2024 Feb 20;25(2):70. doi: 10.31083/j.rcm2502070. eCollection 2024 Feb.
Wellens syndrome is an abnormal electrocardiographic pattern characterized by biphasic (type A) or deeply inverted (type B) T waves in leads V2-V3. It is typically caused by temporary obstruction of the left anterior descending (LAD) coronary artery due to the rupture of an atherosclerotic plaque leading to occlusion. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and even a rarer cause of Wellens Syndrome. It occurs when an intramural hematoma forms, leading to the separation of the tunica intima from the outer layers and creating a false lumen that protrudes into the real lumen, ultimately reducing blood flow and thus resulting in myocardial infarction. Here we report a case of SCAD presenting as an acute coronary syndrome with self-resolving chest pain, slightly elevated myocardial necrosis markers and electrocardiographic changes consistent with Wellens pattern type A first, and type B afterwards, that were not present upon arrival to the emergency department.
Wellens综合征是一种异常心电图模式，其特征为V2-V3导联出现双相（A型）或深倒置（B型）T波。它通常由动脉粥样硬化斑块破裂导致阻塞，引起左前降支（LAD）冠状动脉暂时阻塞所致。自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征的罕见病因，更是Wellens综合征的罕见病因。当壁内血肿形成时就会发生SCAD，导致内膜与外层分离并形成一个突出到真腔内的假腔，最终减少血流，从而导致心肌梗死。在此，我们报告一例SCAD病例，该病例最初表现为急性冠状动脉综合征，胸痛自行缓解，心肌坏死标志物轻度升高，心电图改变符合Wellens A型模式，随后为B型模式，而在到达急诊科时这些改变并不存在。
