Repeat Wellens' syndrome: case report of critical proximal left anterior descending artery restenosis

We describe the case of a 40-year-old woman who presented to the Emergency Department with resolving chest pain. The initial electrocardiogram (ECG) showed biphasic T-waves in V2-V4, which was recognized as Wellens' syndrome, or acute coronary T-wave syndrome. Emergent cardiac catheterization revealed 95% stenosis of the previously placed stent in the proximal left anterior descending artery (LAD). Review of her records from 3 years prior revealed similar ECG findings consistent with Wellens' syndrome, at which time a stent was placed for critical proximal LAD stenosis. We report this case to increase awareness of the T-wave abnormalities associated with Wellens' syndrome. There is significant morbidity and mortality that can occur in the absence of emergent coronary revascularization. This report of repeated Wellens' syndrome in the same patient demonstrates both types of precordial T-wave abnormalities that characterize Wellens' syndrome.