Case Report: Wellens syndrome in acute total occlusion saved by collateral

Abstract

Background: It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report: A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiographic (ECG) changes were suggestive of Wellens syndrome type A. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented ECG before he went for catheterization and based on the second ECG changes were suggestive of an ST elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, near total occlusion in the middle of the left anterior descending artery (LAD) with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit (ICCU), the patient improved and was transferred to the Low Care Unit. Conclusions: The case highlights Wellens syndrome in acute total occlusion with collateral artery.