Wellens syndrome: A warning sign of an impending "catastrophe"

The term acute coronary syndrome includes a set of symptoms and signs attributable to acute myocardial ischemia that is generally due to the rupture or erosion of an atherosclerotic plaque with the consequent formation of a thrombus that totally or partially obstructs the involved coronary artery. It has a wide range of clinical presentations. The electrocardiogram plays an important role in the diagnosis and treatment of acute coronary syndrome, the spectrum includes a normal electrocardiogram, T-wave abnormalities, ST-segment depression, or ST-segment elevation. It is also useful for acute coronary syndrome presentations that are not so typical and can sometimes go unnoticed, such as right or left bundle branch block, posterior wall myocardial infarction, de Winter T wave pattern, and Wellens syndrome. A case of Wellens syndrome was identified in an outpatient cardiology consultation, the patient was immediately referred for urgent invasive coronary angiography, and as a result, a stent was successfully implanted from the ostium of the anterior descending coronary artery. The early identification of these variants is valuable so that the patient receives optimal drug treatment and is referred on time to invasive coronary angiography. The role of the echocardiogram with strain imaging and its contribution to the diagnosis is highlighted.