Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
- unstable angina
- acute coronary syndrome
- coronary stenting
- ST-T alterations
A 45-year-old man presented with new onset, intermittent, typical angina at rest of 6 h duration. His ECG (figure 1A) revealed normal ‘R’ wave progression, no significant ST segment elevation with biphasic ‘T’ waves in leads V2, V3 and V4 suggestive of Type B or an uncommon form of Wellens syndrome.1 2 The patient's coronary angiogram demonstrated critical proximal left anterior descending artery stenosis (figure 2A) and he underwent immediate, successful angioplasty and stenting of the left anterior descending artery (figure 2B). The ECG done 5 min after stenting (figure 1B) showed complete normalisation of the ‘T’ waves in precordial leads. The effect of revascularisation on the Wellens ECG has not been described previously. Delayed repolarisation of the epicardium during ischaemia reverses the direction of progression of ventricular repolarisation leading to reversal of the ‘T’ wave vector, resulting in biphasic ‘T’ waves in mid-precordial leads. This demonstrates that the ECG can be used as a reliable marker of successful revascularisation in Wellens syndrome and reappearance of biphasic ‘T’ waves denotes probable restenosis.
Competing interests None.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the SJICSR ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.