PSEUDO WELLEN'S SYNDROME : THINK OUTSIDE THE HEART TOO
Patel S, Magbanua MLP, and Ananthasubramaniam K. PSEUDO WELLEN'S SYNDROME : THINK OUTSIDE THE HEART TOO. Journal of the American College of Cardiology 2021; 77(18):2797.
Journal of the American College of Cardiology
Background: Wellen's syndrome (WS) is a characteristic ECG pattern in patients with acute coronary syndrome (ACS) and critical left anterior descending artery stenosis. We present a case of pseudo Wellen's syndrome (PWS) with submassive pulmonary embolism (PE) mimicking acute coronary syndrome.
Case: A 63 yr old man with a history of venous thromboembolism presented with acutely worsening dyspnea. He denied chest pain, syncope or heart failure symptoms. He was acutely short of breath with limited speech and tachycardic to 101 beats/min; remaining exam and vitals were unremarkable. Intake blood work was notable for high sensitivity troponin I of 129ng/L with a repeat level of 115 ng/dL. Initial ECG is shown below (Figure 1A).
Decision-making: ECG was concerning for WS though lack of risk factors, decreasing troponin levels and acute dyspnea raised suspicion of a nonischemic etiology. Urgent echocardiogram found a dilated and hypokinetic right ventricle (RV) and normal left ventricular function and wall motion (Figure 1B-C). Chest CT showed extensive bilateral PE involving both main pulmonary arteries (Figure 1D-E). ECG findings were attributed to RV strain and coronary angiography was not pursued. Catheter-directed thrombolysis was performed with improvement in symptoms.
Conclusion: ECG changes are common and varied in PE. This case underscores the importance and awareness of acute right heart strain from PE as a cause of PWS, enabling timely diagnosis and treatment of a life threatening emergency.