Non-Atherosclerotic Myocardial Infarction With a Presentation of Wellens Syndrome

Myocardial infarction (MI) is a critical event that needs timely diagnosis and prompt management. Wellens syndrome can progress to MI if not managed in a timely manner. It implies the underlying critical stenosis of the left anterior descending (LAD) artery of the heart. In this report, we discuss an interesting presentation of pseudo Wellens syndrome in a hypertensive middle-aged woman admitted as a case of Non-ST-elevation myocardial infarction (NSTEMI). During the hospital stay, she had an episode of chest pain with typical ECG changes, suggesting Wellens syndrome. However, upon intervening with coronary angiography, it turned out to be unremarkable for any coronary artery stenosis. She developed another episode of chest pain during her hospital stay with abnormal ECG patterns requiring further investigations with a non-invasive CT scan of coronary arteries and cardiac MRI for any infiltrative diseases. All workups were unremarkable. A multidisciplinary team involving the medical and interventional cardiology departments were involved in the diagnosis, and the patient was labeled as a case of vasospastic angina. She was treated with calcium channel blockers and was followed up as an outpatient for seven months with no further complications. Our main objective was to highlight the interesting phenomenon of Wellens and pseudo-Wellens syndrome. The condition requires early diagnosis and timely management to make sure that no underlying critical pathology is present that can result in fatal complications like MI or cardiac arrest.