Search Our Scientific Publications & Authors

Diagnostics (Basel) 2022 Mar 25;12(4). Epub 2022 Mar 25.

Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari "Aldo Moro", 70124 Bari, Italy.

Wellens' syndrome (WS) is a preinfarction state caused by a sub-occlusion of the proximal left anterior descending coronary artery (LAD). In this case report, for the first time, we describe how this syndrome can be caused by COVID-19 infection and, most importantly, that it can be assessed bedside by enhanced transthoracic coronary echo Doppler (E-Doppler TTE). This seasoned technique allows blood flow Doppler to be recorded in the coronaries and at the stenosis site but has never been tested in an acute setting. Read More

BMC Cardiovasc Disord 2022 04 16;22(1):176. Epub 2022 Apr 16.

Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Yong'an Road, Xichen, Beijing, 100050, People's Republic of China.

Background: Few studies with large sample sizes are available regarding patients with Wellens' syndrome. Therefore, we sought to assess the current incidence, risk factors, clinical presentation and long-term outcomes of this population.

Methods: Among a total of 3528 patients with ACS who underwent angioplasty from 2017 to 2019 in our centre, 2127 NSTE-ACS patients with culprit LAD vessels were enrolled in this study. Read More

Cureus 2022 Feb 11;14(2):e22130. Epub 2022 Feb 11.

Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA.

Wellens' syndrome refers to specific electrocardiographic (ECG) abnormalities of deeply inverted T-waves in the precordial leads, mainly V1-V3, associated with critical stenosis of the proximal left anterior descending (LAD) coronary artery. Identifying this specific pattern on the electrocardiogram is important as emergent treatment can prevent life-threatening myocardial infarction. We present a case of Wellens' syndrome that had a combination of inverted and biphasic T-waves patterns and where timely identification of the abnormal ECG pattern by the emergency physician and prompt intervention by the cardiology team prevented the development of myocardial infarction and hence permanent damage to the heart. Read More

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096211073255

The University of the West Indies, St. Augustine, Trinidad and Tobago.

Wellens' syndrome is an electrocardiographic harbinger of a critical left anterior descending (LAD) coronary artery stenosis in acute coronary syndromes (ACS), whereas pseudo-Wellens' syndrome typically has angiographically normal coronary arteries. Myocardial bridging (MB) occurs when an epicardial coronary artery segment takes a tunneled intramuscular course. We describe a rare case of MB-induced pseudo-Wellens' syndrome in a young patient presenting with unstable angina (USA). Read More

Am J Med 2022 Apr 20;135(4):517-523. Epub 2021 Nov 20.

Division of Cardiovascular Medicine.

Background: The incidence of precordial T changes has been described in athletes and in specific populations, while the etiology in a large patient population admitted to the hospital has not previously been reported.

Methods: All electrocardiograms (ECGs) read by the same physician with new (compared to prior ECGs) or presumed new (no prior ECGs) precordial T wave inversions of >1 mm (0.1 mV) in multiple precordial leads were retrospectively reviewed and various ECG, patient-related, and imaging parameters assessed. Read More

J Gen Fam Med 2021 Nov 6;22(6):353-355. Epub 2021 Jun 6.

Department of Cardiology Matsudo City General Hospital Matsudo Japan.

We report the case of a 30-year-old woman who was referred to our hospital with chest pain. An electrocardiogram showed biphasic T-wave inversions in leads V2-4 compared with that done 2 years ago, suggesting Wellens syndrome, and an emergent coronary angiography revealed significant stenosis of the proximal left anterior descending artery due to coronary artery vasculitis. Although acute coronary syndrome in the young is very rare, coronary artery vasculitis should be considered as a possible etiology, especially in young women with chest pain. Read More

CJEM 2022 03 29;24(2):224-226. Epub 2021 Oct 29.

Division of Emergency Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada.

G Ital Cardiol (Rome) 2021 Nov;22(11):888-890

Dipartimento di Cardiologia, Ospedale "Guglielmo da Saliceto", Piacenza.

A 62-year-old male patient with a history of atypical chest pain ad dyspnea presented to the emergency room during the COVID-19 pandemic. On admission, the ECG showed sinus rhythm with diphasic T waves in lead V2. A high resolution computed tomography revealed signs suggestive of pulmonary infarction and a subsequent nasopharyngeal swab for SARS-CoV-2 was positive. Read More

JAMA Intern Med 2021 12;181(12):1647-1649

Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China.

Maedica (Bucur) 2021 Jun;16(2):216-222

"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

Wellens syndrome has been described as a clinical and electrocardiographic complex that identifies a subset of patients with unstable angina (UA) at an impending risk of myocardial infarction (MI) and death in studies published almost four decades ago, before the wide use of cardiac biomarkers such as troponins. The clinical implications of Wellens sign in a contemporary cohort of patients with non-ST elevation acute coronary syndromes (NSTEACS) is yet to be defined. We performed a prospective analysis of patients with acute coronary syndrome (ACS) and Wellens sign who underwent coronary angiography between January 2018 and December 2019. Read More

Mil Med 2021 Oct 6. Epub 2021 Oct 6.

Department of Cardiology, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA.

Managing patients with chest pain in deployed and austere environments can be extremely challenging for military health care providers. Limited resources, including access to equipment, emergent cardiac catheterization, and cardiac surgery, can lead to deleterious consequences, including myonecrosis and possible death. Wellens syndrome is a form of acute coronary syndrome that involves stenosis of the left anterior descending coronary artery, leading to possible acute myocardial infarction. Read More

Cureus 2021 Jul 7;13(7):e16241. Epub 2021 Jul 7.

Pediatrics, Ministry of Health, Malé, MDV.

Wellens syndrome is a pre-infarction stage due to the critical stenosis of the proximal left anterior descending artery. It is characterized by intermittent chest pain with classical ECG changes. The cardiac biomarker is within the normal limit or only slightly elevated in this condition. Read More

Br J Hosp Med (Lond) 2021 Jul 20;82(7):1-3. Epub 2021 Jul 20.

Department of Cardiology, Hillingdon Hospital, Uxbridge, UK.

Am J Med 2021 11 29;134(11):1365-1367. Epub 2021 May 29.

University of Arizona, Tucson; University of Arizona, Phoenix. Electronic address:

Med Intensiva (Engl Ed) 2021 May 6. Epub 2021 May 6.

Internal Medicine Department, Nuevo Hospital Bocagrande, Cartagena, Colombia.

Cureus 2021 Apr 14;13(4):e14489. Epub 2021 Apr 14.

Cardiology, Upstate University Hospital, Syracuse, USA.

Factor V Leiden deficiency, the most common inherited thrombophilia, is a risk factor for venous thromboembolism in both the heterozygous and homozygous forms. An autosomal dominant genetic condition, the pattern of incomplete penetrance leads to variable manifestations of the disease. The association with arterial thromboembolism remains controversial, with studies indicating modest increases in risk of coronary artery disease, stroke. Read More

J Med Case Rep 2021 Apr 6;15(1):151. Epub 2021 Apr 6.

Department of Cardiology, NewYork-Presbyterian Queens, Flushing, USA.

Background: Pseudo-Wellens syndrome is a rare entity characterized by the presence of electrocardiogram (ECG) changes of Wellens syndrome but without the stenosis of the left anterior descending (LAD) coronary artery. In previous reports, pseudo-Wellens syndrome most commonly resulted from recreational drug use or unidentified etiologies. We present a unique case of pseudo-Wellens syndrome due to sepsis-induced cardiomyopathy and a review of the literature. Read More

Cureus 2021 Feb 11;13(2):e13290. Epub 2021 Feb 11.

Research Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, USA.

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-Cov2), is the causative pathogen of coronavirus disease 2019 (COVID-19), which is primarily described as a respiratory illness. However, a wide array of cardiovascular complications has also been described in the setting of COVID-19. Wellens' syndrome, also regarded as a left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending (LAD) artery stenosis. Read More

Arq Bras Cardiol 2021 02;116(2):363-366

Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP - Brasil.

Spartan Med Res J 2020 Jun 8;5(1):12881. Epub 2020 Jun 8.

Garden City Hospital.

Thebeisan veins are microfistulous connections between a coronary arterial branch directly to a ventricular or atrial chamber. Extensive thebesian veins that empty into the left ventricle can cause typical chest pain symptoms, troponin elevation, and ischemic EKG changes from coronary steal leading to acute coronary syndrome in extreme cases. Literature review exposed a consistent pattern of EKG findings among patients with extensive thebesian veins involving all three major coronary arteries. Read More

Cureus 2021 Jan 29;13(1):e12983. Epub 2021 Jan 29.

Acute Medicine, Pinferfields General Hospital, Wakefield, GBR.

Myocarditis is the inflammation of the myocardium and is a challenging diagnosis owing to the heterogeneity in its etiology, pathogenesis and clinical presentations. It often presents as an acute coronary syndrome (ACS) mimic and hence may pose both diagnostic and therapeutic challenges to treating physicians to reliably differentiate between these two entities. In this case, we discuss a young male whose initial presentation of chest pain was dubious of the acute coronary syndrome but detailed history, physical examination and by careful selection of non-invasive investigations including echo and cardiac magnetic resonance imaging (MRI), led to a diagnosis of acute myocarditis. Read More

Am J Med Sci 2021 10 20;362(4):e37-e38. Epub 2021 Feb 20.

Dokkyo Medical University Hospital, Mibu, Tochigi, Japan. Electronic address:

Am J Case Rep 2021 Feb 3;22:e930125. Epub 2021 Feb 3.

Department of Advanced Heart Failure, Prisma Health, Columbia, SC, USA.

BACKGROUND There are increasing reports of cardiovascular complications associated with coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2. Wellens syndrome, or left anterior descending T-wave syndrome, is diagnosed by a pattern of electrocardiographic (ECG) changes that include inverted or biphasic T waves in leads V2-V3. CASE REPORT A 75-year-old woman presented to the emergency department with a 1-week history of fatigue and progressive shortness of breath who acutely decompensated, necessitating mechanical ventilator support. Read More

QJM 2021 10;114(6):416

Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Rd, Niao-Sung, Kaohsiung 833, Taiwan and Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.

Prehosp Emerg Care 2021 Feb 5:1-7. Epub 2021 Feb 5.

Yale New Haven Medical Center Emergency Medicine Residency Program, New Haven, Connecticut (NP); Department of Emergency Medicine, Cooper University Health Care, New Haven, Connecticut (AS); Center for Emergency Medical Services, Yale New Haven Hospital, New Haven, Connecticut (JM, KB, DJ, DCC); Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut (KB, RC, DJ, DCC).

The management of patients with ST-elevation myocardial infarction (STEMI) is time-critical, with a focus on early reperfusion to decrease morbidity and mortality. It is imperative that prehospital clinicians recognize STEMI early and initiate transport to hospitals capable of percutaneous coronary intervention (PCI) with a door-to-balloon time of ≤90 minutes. Three patterns have been identified as STEMI equivalents that also likely warrant prompt attention and potentially PCI: Wellens syndrome, De Winter T waves, and aVR ST elevation. Read More

Med Clin (Barc) 2021 10 10;157(8):e297-e298. Epub 2020 Dec 10.

Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, España.

J Emerg Med 2021 Mar 8;60(3):355-358. Epub 2020 Dec 8.

Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.

Background: Snake bite is a grossly underreported public health issue in subtropical, tropical suburban, and rural areas of Africa and South Asia. In literature, ophitoxemia (snake bite envenomation) as a cause of acute coronary syndrome (ACS) is limited to very few case reports. Viper envenomation is the most common cause of ACS among snake bites. Read More

Am J Emerg Med 2021 06 28;44:478.e1-478.e4. Epub 2020 Oct 28.

Alameda Health System-Highland Hospital, USA.

Background: Although T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. "anterior Wellens sign"). Read More

Cureus 2020 Sep 11;12(9):e10390. Epub 2020 Sep 11.

Internal Medicine, University of Florida Health-Jacksonville, Jacksonville, USA.

Wellen's syndrome is a pattern on ECG that signifies impending acute myocardial infarction (MI) of the proximal left anterior descending (LAD) artery. This same pattern can also be noted in several benign diseases that may mimic Wellen's syndrome. Here we discuss a 36-year-old patient with no cardiac risk factors who presented with typical angina shortly after smoking marijuana. Read More

Eur J Intern Med 2020 12 10;82:112-113. Epub 2020 Oct 10.

The Johns Hopkins University School of Medicine.