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EGLE CORRADO

Chest Pain: Wellens Syndrome Due to Spontaneous Dissection of the Left Anterior Descending Coronary Artery — A Case Report and Literature Review

  • Authors: 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
  • Publication year: 2024
  • Type: Articolo in rivista
  • OA Link: http://hdl.handle.net/10447/638680

Abstract

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.