Iranian Heart Journal

Iranian Heart Journal

Wellens Syndrome in a Female Patient: When NSTEMI Is Actually a STEMI Equivalent

Document Type : Case Report

Authors
Stevanus Chrisputra Pribadi Supit 1
Meity Ardiana 1
Kevin Luke 1
Wynne Widiarti 2
1 Department of Cardiology and Vascular Medicine, Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
2 Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
Abstract
Background: Specific patterns in the precordial leads of an ECG are hallmarks of Wellens syndrome. Despite its association with imminent anterior myocardial infarction, the syndrome often presents with transient ECG changes, leading to under-recognition and delayed treatment. Female patients are underrepresented in reported cases, reflecting persistent sex-based variations in acute coronary syndrome diagnosis and management.

Case Presentation: A 52-year-old woman was admitted with escalating left-sided chest pain lasting over 20 minutes, following a week of intermittent exertional symptoms. Pretreatment ECG demonstrated biphasic T waves in leads V1–V4, consistent with Wellens Type A pattern. Five hours later, a repeat ECG revealed progression to deep, symmetric T-wave inversions in leads V1–V6, I, and aVL, consistent with Wellens Type B pattern and demonstrating dynamic ischemic evolution. Transthoracic echocardiography showed anterior wall hypokinesis with preserved left ventricular ejection fraction (51%). Coronary computed tomography angiography identified critical proximal left anterior descending artery (LAD) stenosis (99%), which was confirmed on invasive coronary angiography. Following the identification of Wellens syndrome, the patient received definitive treatment through successful percutaneous revascularization with overlapping drug-eluting stents, achieving TIMI grade III flow and complete revascularization.

Conclusions: This case highlights Wellens syndrome as a dynamic and unstable manifestation of critical LAD disease that should be recognized as a true STEMI equivalent. Serial ECG monitoring is essential for detecting rapid pattern evolution, and early invasive management is crucial to prevent extensive anterior myocardial infarction. Heightened clinical vigilance is particularly warranted in female patients to mitigate persistent sex-based disparities and improve outcomes. (Iranian Heart Journal 2026; 27(3): 81-89)
Keywords
Wellens syndrome
occlusion myocardial infarction (OMI)
dynamic ECG evolution
female cardiovascular health
left anterior descending artery
reperfusion injury
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Iranian Heart Journal
Volume 27, Issue 3
Summer 2026
Pages 81-89