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Challenges in Clinical Electrocardiography
March 18, 2019

A Nearly Stressful Situation—A Case of Wellens Syndrome

Author Affiliations
  • 1Brigham and Women’s Hospital, Boston, Massachusetts
  • 2UC San Diego Medical Center, San Diego, California
JAMA Intern Med. 2019;179(5):704-706. doi:10.1001/jamainternmed.2019.0216

A man in his 70s with no history of cardiovascular disease presented to the emergency department after a single episode of chest pressure the previous day. He noted substernal pressure that resolved after 10 minutes of rest but did not complain of any other symptoms. He presented to the emergency department 1 day later at the recommendation of his primary care provider. He had not experienced any chest pressure since the single episode.

On presentation, the patient was hemodynamically stable with a blood pressure of 153/69 mm Hg and heart rate of 63 beats per minute; he was breathing comfortably on room air. His cardiac examination was normal without any murmurs or gallops. His neck veins were nondistended, and breath sounds were normal. Results of his blood chemistry tests and complete blood count were within normal limits. His troponin T hs Gen 5 was 0.32 ng/L (reference range, 0-14 ng/L) with a repeat measurement of 0.30 ng/L 1 hour later. An electrocardiogram (ECG) was performed (Figure 1A).

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