Wellens Syndrome in a 28-Year-Old With Pleuritic Chest Pain

TL;DR

A 28-year-old man with unusual chest pain and a specific ECG pattern was diagnosed with a heart attack, highlighting the importance of recognizing Wellens syndrome despite atypical symptoms.

Contribution

This case report highlights the diagnostic importance of ECG patterns in Wellens syndrome despite atypical patient presentations.

Findings

A 28-year-old male presented with pleuritic chest pain and Wellens syndrome ECG findings.

The patient had an 80% proximal and 100% distal LAD occlusion confirmed by imaging.

The case emphasizes the need for a low threshold of suspicion for Wellens syndrome despite non-typical clinical features.

Abstract

We report a case of a 28-year-old African American male with months of diffuse, pleuritic, intermittent, non-exertional chest pain with elevated troponin and an ECG showing Wellens syndrome; he was found to have myocardial infarction with 80% proximal left anterior descending (LAD) coronary artery occlusion and 100% distal LAD occlusion. This patient's age and symptoms were not typical for cardiac ischemia, although the ECG was typical. Identification and proper management of Wellens syndrome rely on familiarity with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin are all helpful supplemental information, but as shown in this case report, presentations may vary. This case report demonstrates the importance of having a low threshold of suspicion for Wellens syndrome when faced with indicative ECG abnormalities, despite a patient's history of present illness and physical exam being inconsistent with typical presentations of a patient with cardiac ischemia.

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