Author Credentials

Mohamed Salah Mohamed MD, Syed Hamza Waheed MD, Amir Mahmoud MD, Anas Hashem MD, Bipul Baibhav MD, Abdullah Firoze Ahmed MD

Author ORCID Identifier



Wellens syndrome usually indicates critical left anterior descending artery (LAD) occlusion. Pseudo-Wellens syndrome consists of criteria of Wellens syndrome in the absence of critical LAD occlusion. We report a case of Pseudo-Wellens syndrome related to cocaine use. A 52-year-old male with a medical history of hypertension and diabetes, presented with acute retrosternal chest pain of 3 days duration. Physical examination was unremarkable. EKG on presentation showed deep T-wave inversions in leads V2 to V5. Highly sensitive troponin was elevated. The patient admitted to using cocaine daily for the past two months. Due to concerns for Wellens syndrome, the patient had an immediate coronary angiography which revealed mild disease of the LAD (< 30%) only. Inpatient echocardiogram revealed preserved left ventricular ejection fraction and no segmental wall motion abnormalities. Subsequent EKG at the cardiology clinic showed improvement in T-wave inversion. The patient was advised to abstain from using cocaine. As Pseudo-Wellens syndrome is a diagnosis of exclusion, patients with a history of recent cocaine use presenting with acute chest pain history, evidence of myocardial injury, and EKG findings suggestive of Wellens syndrome should undergo an emergent coronary angiogram to exclude critical LAD occlusion.

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Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Figure A PS.png (281 kB)
Figure A: EKG showing deep symmetrical T-wave in leads V2 to V5.

Figure B- PS.png (1552 kB)
Figure B: Coronary angiogram of left coronary system showing Normal LAD.

Figure C. PS.jpg (127 kB)
Figure C: EKG showing improvement of T-wave inversions.