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Paper text:
first described in 1982 by de zwann et al . ( 3 ) , wellens syndrome can be classified as a pattern of ecg changes implying critical stenosis of the lad ( 4 ) .
criteria include a history of anginal chest pain , less than twice the upper limit of normal in cardiac serum markers ( 5 ) , and biphasic or deeply inverted t waves in the precordial leads on an ecg obtained during a pain - free interval ( 6 ) .
this patient presented with type 1 or a wellens , which comprises 25% of cases and has biphasic t waves in lead v2 and v3 ( fig .
the remaining 75% are type 2 or b wellens syndrome , which is deeply inverted , symmetrical t waves in predominantly v2 and v3 ( 1 ) .
this case highlights the need for timely identification of wellens syndrome and the appropriate move to urgent coronary arteriography for possible angioplasty and assessment for emergency cabg .
stress testing should be avoided as this may induce an mi ( 1 , 7 ) .
recognition and appropriate management of wellens is imperative as 75% of non - revascularized patients will progress to acute anterior wall mis within 1 week , if left untreated ( 8) .
recognition of the ekg findings of both type 1 and 2 wellens syndrome is critical to proper management and emergent intervention to avoid large anterior mi .
the authors have not received any funding or benefits from industry or elsewhere to conduct this study .
wellens syndrome , also known as lad coronary t - wave syndrome or the  
 widow maker , is a pre - infarction syndrome with non - classical ischemic ecg changes and unremarkable cardiac biomarkers . 
 this syndrome continues to be a  
 ca n't miss for the clinician as delay in urgent angiography and intervention can result in anterior myocardial infarction , left ventricular dysfunction , arrhythmias , and death . 
 we describe a case followed by a discussion of identification criteria and clinical implications .