Wellens Syndrome in a 28-Year-Old With Pleuritic Chest Pain

We report a case of a 28-year-old African American male with months of diffuse, pleuritic, intermittent, non-exertional chest pain with elevated troponin and an ECG showing Wellens syndrome; he was found to have myocardial infarction with 80% proximal left anterior descending (LAD) coronary artery occlusion and 100% distal LAD occlusion. This patient's age and symptoms were not typical for cardiac ischemia, although the ECG was typical. Identification and proper management of Wellens syndrome rely on familiarity with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin are all helpful supplemental information, but as shown in this case report, presentations may vary. This case report demonstrates the importance of having a low threshold of suspicion for Wellens syndrome when faced with indicative ECG abnormalities, despite a patient's history of present illness and physical exam being inconsistent with typical presentations of a patient with cardiac ischemia.