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.