The ‘widow maker’: Electrocardiogram features that should not be missed
AbstractPatients with Wellen’s syndrome often present with chest pain and found to have specific precordial T-wave changes on the electrocardiogram (ECG). They subsequently develop a large anterior wall myocardial infarction. These specific electrocardiographic abnormalities are associated with critical stenosis of the proximal left anterior descending coronary artery (LAD). This syndrome is often under-recognised and has fatal consequences; it is, therefore, also known as the widow maker. We highlight a case of a 39-year old gentleman who had a history of coronary artery disease and typical ECG characteristics of Wellen’s syndrome.
1. De Zwaan C, Bar FW, Janssen JH, et al. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J. Mar 1989; 117(3):657-65.
Nicole E Mead, Keally P O’Keefe. Wellen’s Syndrome: An ominous EKG pattern. Journal of Emergencies, Trauma and Shock. Sept-Dec 2009; 2(3): 206-208.
Moore KL, Dalley AF. Thorax. In: Clinically Oriented Anatomy. 4th ed. Baltimore, Maryland: Lippincott Williams & Wilkins; 1999:135.
Tandy TK, Bottomy DP, Lewis JG. Wellen’s’ syndrome. Ann Emerg Med. Mar 1999;33(3):347-51.
Aufderheide TP, Gibler WB. Acute ischemic coronary syndromes. In: Rosen P, Barkin R, eds. Emergency medicine: concepts and clinical practice, 4th edn. St Louis: Mosby–Year Book; 1998:1688–91.
Haines DE, Raabe DS, Gundel WD, Wackers T. Anatomic and prognostic significance of new T-wave inversion in unstable angina. Am J Cardiol. 1983; 52:14–8.
John R. Kapoor et all. Isolated Disease of the Proximal Left Anterior Descending Artery; Comparing the Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Surgery, J Am Coll Cardiol Intv. 2008; 1(5): 483-491.
Tatli E, Aktoz M, Buyuklu M, Altun A. Wellen’s’ syndrome: the lectrocardiographic finding that is seen as unimportant. Cardiol J.2009;16(1):73-5.