A Case of Wellens Syndrome Combined with De Winter Syndrome

Zhixiong Zhong; JueTong Chen; Ning Xu; Zhichao Qiu; Jianyong Zhang; Guibin Liu; Fanchao Zeng

doi:doi:10.11648/j.cmr.20221103.11

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A Case of Wellens Syndrome Combined with De Winter Syndrome

Zhixiong Zhong, JueTong Chen, Ning Xu, Zhichao Qiu, Jianyong Zhang, Guibin Liu, Fanchao Zeng

Published in Clinical Medicine Research (Volume 11, Issue 3)

Received: 3 April 2022 Accepted: 6 May 2022 Published: 12 May 2022

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Abstract

This paper reports a typical case of Wellens syndrome combined with De Winter syndrome. The male patient was admitted with "one day chest pain". He is 64 years old. He had chest pain without obvious inducement. Preliminary diagnosis: coronary heart disease unstable angina pectoris. The Electrocardiogram of this case is typical of Wellens syndrome. The patient's Electrocardiogram pseudonormalized during the onset of chest pain, and no significant ST-T changes were observed. After being admitted to hospital, chest pain was relieved. In the case of this case, when the chest pain occurred again, the electrocardiogram of the patient showed a 1-3mm depression of J point in lead V2-V6, followed by symmetrical high tip of T wave and normal ECG changes in QRS wave. Which was in line with the characteristics of electrocardiogram changes in De Winter syndrome. Coronary angiography results: right dominant type, no stenosis in LM, LCX and RCA, and 90%-95% stenosis in the middle part of LAD. The Electrocardiogram of the patient showed dynamic evolution of ST-T. Wellens syndrome and De Winter syndrome successively appeared. It suggests that severe proximal stenosis of the anterior descending artery is accompanied by coronary spasm and the possibility of spontaneous remission. Which will lead to changes of electrocardiograph in ST-T. For these patients, it is necessary to observe the changes of the condition closely and monitor the changes of electrocardiogram dynamically. It is likely to progress to acute extensive anterior wall myocardial infarction without further treatment. So it is necessary perform coronary intervention in time.

Published in	Clinical Medicine Research (Volume 11, Issue 3) This article belongs to the Special Issue Epigenetic Modification of Essential Hypertension Gene and Gene Therapy
DOI	10.11648/j.cmr.20221103.11
Page(s)	36-41
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Wellens Syndrome, De Winter Syndrome, Stenosis of Anterior Descending Artery

References

[1]	De Zwaan C, Bar FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction [J]. Am Heart J, 1982, 103: 730-736.
[2]	Kobayshi A, Misumida N, Kanei Y, et al. CRT-111 prevalence and prognostic value of wellens sign in patients with Non ST elevation myocardial infarction [J]. JACC: Cardiovascular Interventions, 2015, 8 (2): S11-12.
[3]	Gaobo Wu, Lei Shao, Bingfeng Hai, et al. A comparative study of coronary lesions and risk assessment in type 1 and type 2 Wellens syndrome [J]. Journal of Zhengzhou University, 2018, 53 (3): 365-369.
[4]	Alsaab A, Hira RS, Alam M, et al. Usefulness of T wave inversion in leads with ST elevation on the presenting electrocardiogram to predict spontaneous reperfusion in patients with anterior ST elevation acute myocardial infarction [J]. Am J Cardiol, 2014, 113 (2): 270-273.
[5]	Akhtar P, Rizvi SN, Tahir F, et al. Angiocardiographic findings in patients with biphasic T wave inversion in precordial leads [J]. J Pak Med Assoc, 2012, 62 (6): 548-550.
[6]	De Winter RJ, Verouden NJ, Wellens HJ, et al. A new ECG sign of proximal LAD occlusion [J.] N Engl Med, 2008, 359 (19): 2071.
[7]	Zhiqing Xiang, Junhua An, Fujun Wang. One case alternated between De Winter ST-T changes and Wellens syndrome ECG changes [J]. Chinese Journal of Cardiac Pacing and electrophysiology, 2016, 30 (1): 93-94.
[8]	Yuansheng Liu. Special changes in electrocardiogram of coronary heart disease. [J]. Journal of Clinical electrocardiology, 2017, 26 (1): 1-2.
[9]	Fiol SM, Baye` s d LA, Carrillo LA, et al. The “De Winter Pattern” can progress to ST segment elevation acute coronary syndrome [J]. Rev Esp Cardiol, 2015, 68 (11): 1042-1043.
[10]	Qayyum H, Hemaya S, Squires J, et al. Recognizing the de Winter ECG pattern-A time critical electrocardiographic diagnosis in the Emergency Department [J]. Journal of Electrocardiology, 2018, 51 (1): 392-392.
[11]	Ning Xu, Ying You, Xiongguan Wang. Characteristics of coronary artery occlusion in De Winter syndrome [J]. Chinese Journal of Cardiac Pacing and electrophysiology, 2019, 33 (5): 419-421.
[12]	Zipeng Yao, Yanhong Long, Lin Wang. Ecg changes in 3 cases of De Winter syndrome [J]. Journal of Clinical Cardiovascular Disease, 2019, 35 (6): 579-581.
[13]	De Winter RW, Adams R, Verouden NJ, et al. Precordial junctional ST segment depression with tall symmetric T waves signifying proximal LAD occlusion, case reports of STEMI equivalence [J]. Electrocardiol, 2016, 49 (1): 76 -80.
[14]	Alahmad Y, Sardar S, Swehli H. De Winter T-wave Electrocardiogram Pattern Due to Thromboembolic Event: A Rare Phenomenon [J]. Heart Views, 2020, 21 (1): 40-44. DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_90_19.
[15]	Ssdf sfLi XY, Li X, Man QS, et al. An electrocardiogram case of De Winter’ s T-waves evolving into Wellens’ waves [J]. Chin J Cardiol, 2019, 47 (11): 918-920. DOI: 10.3760/cma.j.issn.0253-3758. 2019. 11. 013.
[16]	Xu N, You Y, Wang XG. Coronary occlusion analysis of De Winter syndrome [J]. Chin J Cardiac Pacing Electrophysiol, 2019, 33 (5): 419-421. DOI: 10. 13333/j.cnki.cjcpe. 2019. 05. 006.

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APA Style

Zhixiong Zhong, JueTong Chen, Ning Xu, Zhichao Qiu, Jianyong Zhang, et al. (2022). A Case of Wellens Syndrome Combined with De Winter Syndrome. Clinical Medicine Research, 11(3), 36-41. https://doi.org/10.11648/j.cmr.20221103.11

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ACS Style

Zhixiong Zhong; JueTong Chen; Ning Xu; Zhichao Qiu; Jianyong Zhang, et al. A Case of Wellens Syndrome Combined with De Winter Syndrome. Clin. Med. Res. 2022, 11(3), 36-41. doi: 10.11648/j.cmr.20221103.11

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AMA Style

Zhixiong Zhong, JueTong Chen, Ning Xu, Zhichao Qiu, Jianyong Zhang, et al. A Case of Wellens Syndrome Combined with De Winter Syndrome. Clin Med Res. 2022;11(3):36-41. doi: 10.11648/j.cmr.20221103.11

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@article{10.11648/j.cmr.20221103.11,
  author = {Zhixiong Zhong and JueTong Chen and Ning Xu and Zhichao Qiu and Jianyong Zhang and Guibin Liu and Fanchao Zeng},
  title = {A Case of Wellens Syndrome Combined with De Winter Syndrome},
  journal = {Clinical Medicine Research},
  volume = {11},
  number = {3},
  pages = {36-41},
  doi = {10.11648/j.cmr.20221103.11},
  url = {https://doi.org/10.11648/j.cmr.20221103.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20221103.11},
  abstract = {This paper reports a typical case of Wellens syndrome combined with De Winter syndrome. The male patient was admitted with "one day chest pain". He is 64 years old. He had chest pain without obvious inducement. Preliminary diagnosis: coronary heart disease unstable angina pectoris. The Electrocardiogram of this case is typical of Wellens syndrome. The patient's Electrocardiogram pseudonormalized during the onset of chest pain, and no significant ST-T changes were observed. After being admitted to hospital, chest pain was relieved. In the case of this case, when the chest pain occurred again, the electrocardiogram of the patient showed a 1-3mm depression of J point in lead V2-V6, followed by symmetrical high tip of T wave and normal ECG changes in QRS wave. Which was in line with the characteristics of electrocardiogram changes in De Winter syndrome. Coronary angiography results: right dominant type, no stenosis in LM, LCX and RCA, and 90%-95% stenosis in the middle part of LAD. The Electrocardiogram of the patient showed dynamic evolution of ST-T. Wellens syndrome and De Winter syndrome successively appeared. It suggests that severe proximal stenosis of the anterior descending artery is accompanied by coronary spasm and the possibility of spontaneous remission. Which will lead to changes of electrocardiograph in ST-T. For these patients, it is necessary to observe the changes of the condition closely and monitor the changes of electrocardiogram dynamically. It is likely to progress to acute extensive anterior wall myocardial infarction without further treatment. So it is necessary perform coronary intervention in time.},
 year = {2022}
}

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TY - JOUR
T1 - A Case of Wellens Syndrome Combined with De Winter Syndrome
AU - Zhixiong Zhong
AU - JueTong Chen
AU - Ning Xu
AU - Zhichao Qiu
AU - Jianyong Zhang
AU - Guibin Liu
AU - Fanchao Zeng
Y1 - 2022/05/12
PY - 2022
N1 - https://doi.org/10.11648/j.cmr.20221103.11
DO - 10.11648/j.cmr.20221103.11
T2 - Clinical Medicine Research
JF - Clinical Medicine Research
JO - Clinical Medicine Research
SP - 36
EP - 41
PB - Science Publishing Group
SN - 2326-9057
UR - https://doi.org/10.11648/j.cmr.20221103.11
AB - This paper reports a typical case of Wellens syndrome combined with De Winter syndrome. The male patient was admitted with "one day chest pain". He is 64 years old. He had chest pain without obvious inducement. Preliminary diagnosis: coronary heart disease unstable angina pectoris. The Electrocardiogram of this case is typical of Wellens syndrome. The patient's Electrocardiogram pseudonormalized during the onset of chest pain, and no significant ST-T changes were observed. After being admitted to hospital, chest pain was relieved. In the case of this case, when the chest pain occurred again, the electrocardiogram of the patient showed a 1-3mm depression of J point in lead V2-V6, followed by symmetrical high tip of T wave and normal ECG changes in QRS wave. Which was in line with the characteristics of electrocardiogram changes in De Winter syndrome. Coronary angiography results: right dominant type, no stenosis in LM, LCX and RCA, and 90%-95% stenosis in the middle part of LAD. The Electrocardiogram of the patient showed dynamic evolution of ST-T. Wellens syndrome and De Winter syndrome successively appeared. It suggests that severe proximal stenosis of the anterior descending artery is accompanied by coronary spasm and the possibility of spontaneous remission. Which will lead to changes of electrocardiograph in ST-T. For these patients, it is necessary to observe the changes of the condition closely and monitor the changes of electrocardiogram dynamically. It is likely to progress to acute extensive anterior wall myocardial infarction without further treatment. So it is necessary perform coronary intervention in time.
VL - 11
IS - 3
ER -

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Author Information

Zhixiong Zhong

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China
JueTong Chen

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China
Ning Xu

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China
Zhichao Qiu

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China
Jianyong Zhang

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China
Guibin Liu

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China
Fanchao Zeng

Department of Cardiology, The First People's Hospital of Shaoguan City, Shaoguan, China

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APA Style

Zhixiong Zhong, JueTong Chen, Ning Xu, Zhichao Qiu, Jianyong Zhang, et al. (2022). A Case of Wellens Syndrome Combined with De Winter Syndrome. Clinical Medicine Research, 11(3), 36-41. https://doi.org/10.11648/j.cmr.20221103.11

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ACS Style

Zhixiong Zhong; JueTong Chen; Ning Xu; Zhichao Qiu; Jianyong Zhang, et al. A Case of Wellens Syndrome Combined with De Winter Syndrome. Clin. Med. Res. 2022, 11(3), 36-41. doi: 10.11648/j.cmr.20221103.11

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AMA Style

Zhixiong Zhong, JueTong Chen, Ning Xu, Zhichao Qiu, Jianyong Zhang, et al. A Case of Wellens Syndrome Combined with De Winter Syndrome. Clin Med Res. 2022;11(3):36-41. doi: 10.11648/j.cmr.20221103.11

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@article{10.11648/j.cmr.20221103.11,
  author = {Zhixiong Zhong and JueTong Chen and Ning Xu and Zhichao Qiu and Jianyong Zhang and Guibin Liu and Fanchao Zeng},
  title = {A Case of Wellens Syndrome Combined with De Winter Syndrome},
  journal = {Clinical Medicine Research},
  volume = {11},
  number = {3},
  pages = {36-41},
  doi = {10.11648/j.cmr.20221103.11},
  url = {https://doi.org/10.11648/j.cmr.20221103.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20221103.11},
  abstract = {This paper reports a typical case of Wellens syndrome combined with De Winter syndrome. The male patient was admitted with "one day chest pain". He is 64 years old. He had chest pain without obvious inducement. Preliminary diagnosis: coronary heart disease unstable angina pectoris. The Electrocardiogram of this case is typical of Wellens syndrome. The patient's Electrocardiogram pseudonormalized during the onset of chest pain, and no significant ST-T changes were observed. After being admitted to hospital, chest pain was relieved. In the case of this case, when the chest pain occurred again, the electrocardiogram of the patient showed a 1-3mm depression of J point in lead V2-V6, followed by symmetrical high tip of T wave and normal ECG changes in QRS wave. Which was in line with the characteristics of electrocardiogram changes in De Winter syndrome. Coronary angiography results: right dominant type, no stenosis in LM, LCX and RCA, and 90%-95% stenosis in the middle part of LAD. The Electrocardiogram of the patient showed dynamic evolution of ST-T. Wellens syndrome and De Winter syndrome successively appeared. It suggests that severe proximal stenosis of the anterior descending artery is accompanied by coronary spasm and the possibility of spontaneous remission. Which will lead to changes of electrocardiograph in ST-T. For these patients, it is necessary to observe the changes of the condition closely and monitor the changes of electrocardiogram dynamically. It is likely to progress to acute extensive anterior wall myocardial infarction without further treatment. So it is necessary perform coronary intervention in time.},
 year = {2022}
}

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