The sick LADy who cried wolf: A case of Wellens’ syndrome presenting in the shadow of chronic sickle cell pain

Introduction: Chest pain is a common presenting complaint in the emergency centre (EC), with a very wide differential diagnosis. Evaluation of patients with chest pain in the EC is geared toward rapidly identifying and treating the subset of patients with potentially life-threatening causes, including acute coronary syndromes. ECG and cardiac biomarkers are indispensable tools in this endeavor. Case report: A 47 year old African woman presented to the EC with chest pain; her ECG revealed findings typical of Wellens’ syndrome. Subsequent coronary angiography revealed near-total proximal LAD occlusion. Discussion: Wellens’ syndrome refers to a pre-infarction stage of acute coronary syndrome with distinct ECG T-wave changes that strongly predict the presence of critical LAD coronary artery stenosis; it is a harbinger of impending extensive anterior myocardial infarction. Emergency physicians must be able to recognize its ECG features and institute appropriate intervention