Wellen’s syndrome was firstly described by deZwaal and Wellen’s et al in 1982.  Wellen’s sign on electrocardiography (ECG) is characterized by biphasic or deeply inverted T wave in anterior chest leads V2- V3 which indicates critical left anterior descending artery (LAD) stenosis. This may progress to anterior myocardial infarction and left ventricular systolic dysfunction. We aimed to analyze the risk factors, left ventricular systolic function, troponin leak and angiographic profile of Wellen’s ECG.

A retrospective analysis of acute coronary syndrome (ACS) with Wellen’s ECG who had undergone invasive coronary angiography in a tertiary care centre in Sri Lanka from October 2020 to March 2022.Inclusion criteria: age above 18 and ACS with Wellen’s ECG.This study excluded patient with previous history of anterior myocardial infarction, past coronary stenting, coronary artery bypass grafting (CABG) and cardiomyopathy.Data obtained from angiographic findings, percutaneous coronary intervention (PCI) details, clinical notes and echocardiography reports.

A total of 22 patients were included. Males were 15 (68.18%). The mean age was 52.90 years and the youngest was 23 years. Prevalence of hypertension and diabetes were 6 (27.27%) and no risk factors were found in 13 (59.09%). Smoking in 5 (22.72%) while heroin and marijuana in 1 (4.54%). Troponin rise in 17 (77.27%). Preserved left ventricular systolic function (LVEF) (50- 60%) in 8 patients (36.36%), mildly reduced LVEF (40-49%) in 9 (40.90%) and reduced LVEF (< 40%) in 5 (22.72%) patients.Single vessel disease (LAD only) 5 (22.72%), two vessel disease in 3 (13.63%) and three vessel disease 7 (31.81%).  Tight right coronary disease along with moderate LAD lesion in 2 (9.09%). Both critical LAD and circumflex lesion in 2 (9.09%) and total occlusion of LAD in 1 (4.54%). Critical left main disease (LMA) and ramus intermedius stenosis were identified 2 and 1 (9.09%, 4.54%) respectively. Normal angiography in 3 (13.63%).Multivessel PCI, 08 (36.36%%) while CABG for 2 (9.09%). PCI to LAD to LMA was 1 (4.545), PCI to LAD (n5) 22.27%, PCI to RCA (n2) 9.09% and PCI to intermediate vessel was 01 (4.54%)

Wellen’s sign on ECG is not a ST elevated myocardial infarction. However, it indicates critical LAD stenosis. Rarely it can be a presenting manifestation of significant left main coronary artery disease. In the presence of multiple risk factors, the chances of multivessel disease is high. Timely intervention could reduce the progression of heart failure and mortality.