Late diagnosis of Wellens syndrome in a patient presenting with an atypical acute coronary syndrome

摘要

Atypical myocardial infarctions (MIs) are one of the more feared diagnoses among cardiologists, emergency department physicians, and internists for patients presenting with presumed noncardiac chest pain. Delays in care for patients presenting with atypical MIs can lead to increases in morbidity and mortality. This is also true in the case of Wellens syndrome, where delays in coronary revascularization can also lead to left ventricular dysfunction and death. Here, we report the case of a 48-year-old man with no known risk factors for coronary disease who presents with atypical symptoms, a very late rise in serum troponin, and electrocardiogram changes consistent with Wellens syndrome as part of an acute non-ST elevation MI.