WELLEN'S SYNDROME

1. PATHOPHYSIOLOGY

1.1. Wellen's syndrome is therefore hypothesized that an incidental reperfusion following occlusion of the LAD. The reperfusion may be unstable and this vessel may re-occlude, causing further angina and ischemia. This cycle of occlusion and reperfusion will continue until the coronary blood supply can no longer be reestablished and an acute myocardial infarction occurs.

2. ETIOLOGY

2.1. Atherosclerotic plaque

2.2. Coronary artery vasospasm (cocaine is one possible cause)

2.3. Increased cardiac demand

2.4. Generalized hypoxia

3. DIAGNOSTICS CRITERIA

3.1. ECG

3.1.1. "Type A" Biphasic T Wave, with initial positivity and terminal negativity

3.1.2. "Type B" Deeply and symmetrically inverted T Wave in Precordial leads: Deep symmetrical t wave inversion at V2-V3, aVL

3.2. Blood Tests

3.2.1. Normal or minimally elevated cardiac enzyme levels: hs-Troponin I = 3,593.4--->3,700--->6,479 ng/L

3.3. Echocardiography

3.4. Coronary Angiography

3.5. Cardiac Catheterization

3.6. Plain Radiography and CT of Chest

4. TREATMENT & MANAGEMENT

4.1. MEDICINES

4.1.1. Thrombolytic/Anticoagulant/Antiplatelets drugs

4.1.1.1. ASA (81) 4 tabs oral stat & Con't 81 mg/Day

4.1.1.2. Ticagrelor (90) 2 tabs oral stat & Con't 180 mg/Day

4.1.1.3. Enoxaparin 0.8 ml SC q 12 hrs.

4.1.2. Nitroglycerin

4.1.2.1. ISDN (5) 1 tab SL stat

4.2. MEDICAL PROCEDURE/SURGERY

4.2.1. PCI

4.2.2. Coronary Angiography

4.2.3. CABG

4.2.4. Cardiac Catheterization

5. CLINICAL PRESENTATION

5.1. Chest pain described as pressure, tightness, or heaviness

5.2. Pain that is typically induced by activity and relieved by rest

5.3. Radiation of pain to the jaw, shoulder, or neck

5.4. Precipitated by exertion

5.5. Diaphoresis

5.6. Nausea

5.7. Vomiting

5.8. Fatigue

6. RISK FACTORS

6.1. Hypertension: 164/94mmHg

6.2. Hyperlipidemia

6.3. Hypercholesterolemia

6.4. Smoking history: 23 packs/year

6.5. Obesity: BW 84 kgs, BMI 30.85

6.6. Increased age: 63 Yrs.

6.7. Diabetes Mellitus

6.8. Metabolic syndrome

6.9. Family history of premature heart disease

6.10. Occupational stress

7. PREVENTION:

7.1. •Quit smoking

7.2. •Maintaining a healthy weight

7.3. •Heart-healthy eating

7.4. •Managing stress

7.5. •Physical activity