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Wellens Syndrome in an Elderly Female with Known mLAD Disease

Description

An 88 year-old female with known 70% mLAD occlusion presented to the emergency department after awakening with central, pressure-like chest pain. Her electrocardiogram shows minimal ST elevation in V1-V3 associated with deep T-wave inversions (TWIs) from V1-V5 typically seen in reperfusion of the LAD shortly after sudden occlusion, also known as Wellens Syndrome. The deep TWI are most prominent in V2-V3 with largest STE of 1mm in V2 and no precordial Q waves or any perturbation in R wave progression. Interestingly, this pattern usually occurs in the absence of chest pain following angina and the TWIs progress from biphasic (Type A) to symmetric inversion (Type B) with the possibility for "pseudo-normalization" if the LAD lesion were to reocclude. LHC showed 90% mLAD & 80% OM2 occlusions.

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