Whispers of the Heart: Myocardial Infarction Induced by Beta Agonists

Wellens syndrome is a relatively common yet fatal presentation of acute coronary syndrome and is considered a ST-segment elevation myocardial infarction (STEMI) equivalent. It often indicates an obstructive lesion in the proximal left anterior descending (LAD) artery and warrants early coronary angiography and revascularisation. We report the case of an elderly female in her 60s who presented to a primary health care centre with an acute-onset shortness of breath. A provisional diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD) was made, and the patient was nebulized with salbutamol and cortisone. However, her condition worsened over the next hour, and she was transferred to our hospital. On arrival at our hospital, the patient was hypotensive and extremely distressed. A 12-lead ECG showed STEMI with elevation in leads V1-V6, lead I, and aVL. A diagnosis of anterior wall MI (AWMI) was confirmed. Angiography revealed thrombotic occlusion of the proximal LAD artery. This was subsequently tackled by implanting a drug-eluting Stent. Our patient presented with dyspnoea (an uncommon anginal equivalent) and mild wheezing on auscultation, which initially led to an erroneous diagnosis of acute exacerbation of COPD, as the serum troponins were initially normal and the ECG seemed apparently normal. On retrospective analysis, the clinician had missed a subtle biphasic T wave in V1-V3 with preserved R waves, suggesting Wellens syndrome.