IMR Press / RCM / Volume 25 / Issue 2 / DOI: 10.31083/j.rcm2502070
Open Access Review
Chest Pain: Wellens Syndrome Due to Spontaneous Dissection of the Left Anterior Descending Coronary Artery — A Case Report and Literature Review
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1 Internal Medicine and Stroke Care Ward, University Hospital Policlinico P. Giaccone, 90127 Palermo, Italy
2 Coronary Intensive Care Unit, University Hospital Policlinico P. Giaccone, 90127 Palermo, Italy
*Correspondence: (Giuseppe Clemente)
Rev. Cardiovasc. Med. 2024, 25(2), 70;
Submitted: 13 September 2023 | Revised: 19 November 2023 | Accepted: 22 November 2023 | Published: 20 February 2024
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Wellens syndrome is an abnormal electrocardiographic pattern characterized by biphasic (type A) or deeply inverted (type B) T waves in leads V2–V3. It is typically caused by temporary obstruction of the left anterior descending (LAD) coronary artery due to the rupture of an atherosclerotic plaque leading to occlusion. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and even a rarer cause of Wellens Syndrome. It occurs when an intramural hematoma forms, leading to the separation of the tunica intima from the outer layers and creating a false lumen that protrudes into the real lumen, ultimately reducing blood flow and thus resulting in myocardial infarction. Here we report a case of SCAD presenting as an acute coronary syndrome with self-resolving chest pain, slightly elevated myocardial necrosis markers and electrocardiographic changes consistent with Wellens pattern type A first, and type B afterwards, that were not present upon arrival to the emergency department.

chest pain
electrocardiographic patterns
spontaneous left anterior descending coronary artery dissection
Wellens syndrome
Wellens pattern Type A and Type B
acute coronary syndrome
Fig. 1.
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