INTRODUCTION
Wellens syndrome, also called left ascending artery (LAD) coronary syndrome or widow maker, was first described by de Zwaan et al in patients with unstable angina during a pain-free period with electrocardiographic (ECG) changes.1 There are two types of the syndrome, including type A and type B manifesting with biphasic T waves and deeply inverted T waves in leads V2-V3, respectively.2 If the patients present with these types of ECG, it is highly specific for severe, proximal stenosis of the left anterior descending coronary artery.3 Normally, when Wellens syndrome patients come to the emergency department or cardiovascular center, they do not have chest pain with normal or slightly elevated cardiac enzymes.4 However, it is crucial to attach the importance of the ECG patterns because these patients are at high risk for acute myocardial infarction with a large acute anterior wall. Percutaneous coronary intervention (PCI) is the definitive treatment to relieve the occlusion in LAD.5, 6
The definition of cardiac electrical storm (ES) is three or more episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in any interval of 24 hours.7 There are many causes of ES, which can be divided into two categories scar-mediated re-entry due to previous myocardial infarction and reversible causes (acute ischemia, acute decompensated heart failure, electrolyte abnormalities, drug toxicity, sepsis and thyrotoxicosis).8 Electrical storm is considered a critical and severe situation both on management of hemodynamically unstable arrhythmias and its association with a significantly elevated sympathetic tone, which are likely to trigger further arrhythmias.9 Normally, patients with ES are treated with antiarrhythmic medications serially and suffer repeatedly from electrical shocks.10 The key intervention in the electrical storm is to revascularize if patients experiencing myocardial infarction and to block the sympathetic system through beta-blockers, especially propranolol; combined with analgesics and sedatives along with the control of serum electrolytes (particularly Mg2+, K+) at high levels by the infusion of intravenous electrolyte solution.7, 11-13
We would like to present a case of Wellens syndrome suffering from the cardiac electrical storm and how we successfully managed the patient.