Patient Presenting With Unilateral Visual Loss: Amaurosis Fugax

Introduction and Purpose: Wellens syndrome is an electrocardiographic finding that suggests a critical proximal left anterior descending (LAD) artery stenosis.It is typically seen in patients with a history of chest pain, and the characteristic T wave changes appear after the pain resolves.First described by Zwaan and Wellens in 1982, it is a strong predictor of anterior myocardial infarction (MI) if left untreated.There are two ECG patterns:Type A: Deep, symmetric T wave inversions in V2-V3Type B: Biphasic T waves in V2-V3, sometimes with isoelectric or mildly elevated ST segmentsEarly recognition is vital to prevent a major cardiac event.Materials and Methods: A 63-year-old male with known diabetes, hypertension, and COPD presented to the emergency department with typical chest pain lasting for one week, occurring at rest.On physical exam, heart sounds were rhythmic with no murmur.Blood pressure was 140/85 mmHg.ECG showed biphasic T waves in anterior leads, consistent with a Wellens pattern.Echocardiography revealed an ejection fraction of 40%, anterior hypokinesia, and apical akinesia.Laboratory tests: Troponin I: 10.17, Troponin T: 506.7.The patient was diagnosed with acute coronary syndrome and admitted to the coronary ICU for early invasive intervention.Coronary angiography findings:LMCA: NormalLAD: 90% stenosis at proximal and mid segmentsCX: 30% mid-segment stenosisRCA: 30% proximal stenosisA successful revascularization was performed Results and Conclusion: Wellens syndrome is a critical ECG finding indicating severe LAD stenosis and a high risk for anterior MI.It presents during a pain-free interval, making it easy to miss.Early identification and urgent intervention are essential.Emergency physicians and cardiologists must be aware of this pattern to ensure timely and life-saving management.