Pseudo-Wellens Syndrome Caused by Myocardial Bridging.

BACKGROUND

Wellens syndrome is a preinfarction electrocardiographic pattern classically associated with critical proximal left anterior descending artery stenosis. However, nonatherosclerotic conditions, including myocardial bridging, may mimic this pattern.

CASE SUMMARY: A 58-year-old man presented with intermittent chest pain and Wellens T-wave changes in the anterior leads. High-sensitivity troponin T levels were normal. Coronary angiography revealed normal coronary arteries with a mid left anterior descending myocardial bridge and no fixed stenosis. Beta-blocker therapy was deferred owing to baseline bradycardia.

DISCUSSION: Myocardial bridging may produce a pseudo-Wellens pattern through dynamic systolic compression and transient ischemia.

TAKE-HOME MESSAGE: Recognition of this phenocopy is essential to avoid misdiagnosis and unnecessary intervention.