Wellens’ Syndrome with Positive T Wave in Lead aVR Suggesting Severe Three-Vessel Coronary Arterial Disease

Non-ST-elevation myocardial infarction (NSTEMI) showing biphasic or deep negative T waves in lead V2-3 suggests the presence of a severe stenotic lesion in the proximal left anterior descending artery, called Wellens' syndrome. We report a case of NSTEMI with a positive T wave in lead aVR and widespread negative T waves in the precordial and inferior leads, presumed to be Wellens' syndrome, resulting in three-vessel severe coronary artery disease. This report highlights the importance of identifying a positive T wave in lead aVR to avoid overlooking severe organic stenosis of the coronary arteries. J. Med. Invest. 72 : 451-454, August, 2025.