[Skip to Navigation]
Views 2,327
Citations 0
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).

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words