The term Wellens syndrome should be extended to include inferior and posterior wall coronary artery disease: a case report

BACKGROUND: According to current terminology, Wellens syndrome's electrocardiographic (ECG) signs are present in leads V2-3 and indicate a critical proximal left anterior descending coronary artery (LAD) stenosis, suggesting an impending anterior myocardial infarction. This case report highlights that the Wellens pattern can be observed in localisations other than the anterior leads, and that the underlying pathomechanism of Wellens syndrome is not specific to the LAD. CASE PRESENTATION: An 83-year-old female patient with high cardiovascular risk presented to the emergency department with symptoms characteristic of Wellens syndrome. However, the Wellens pattern appeared in the ECG leads representing the inferior and posterior walls. Urgent coronary angiography confirmed a 99% ostial stenosis of the dominant right coronary artery, which was successfully treated with a drug-eluting stent. CONCLUSIONS: We suggest extending the Wellens syndrome terminology to include inferior and posterior wall coronary artery disease, based on electrocardiographic abnormalities in locations other than the anterior, if the clinical presentation corresponds.