An Unusual Presentation of Myocardial Ischemia and Coexisting Asthma Exacerbation With a Pseudo-Wellens Sign: A Case Report.

Cardiovascular complications, including myocardial ischemia, can occur during acute asthma exacerbations due to overlapping inflammatory and physiological mechanisms. ECG abnormalities and elevated cardiac biomarkers may mimic acute coronary syndrome, complicating diagnosis and management. We present a case of a 60-year-old woman with a history of long-standing asthma and hypertension who presented with chest pain and shortness of breath during an asthma exacerbation. Clinical evaluation revealed diffuse wheezing, deep T-wave inversions on ECG, and elevated cardiac biomarkers, initially raising concern for Wellens syndrome. Transthoracic echocardiography showed mild left ventricular hypertrophy and regional wall motion abnormalities, but coronary angiography demonstrated no obstructive coronary artery disease. The patient's symptoms and oxygen saturation improved with bronchodilator and corticosteroid therapy, supporting a diagnosis of pseudo-Wellens syndrome in the setting of status asthmaticus. This case highlights the importance of recognizing pseudo-Wellens syndrome as a potential mimic of true myocardial ischemia to avoid unnecessary invasive procedures and guide appropriate treatment.