| Summary: | Background: Wellens' syndrome (WS) is characterized by a biphasic or deeply inverted T wave appearing in both leads V2 and V3 of an electrocardiogram (ECG) with angina, indicating critical stenosis of the proximal part of the left anterior descending (LAD) artery. When managing patients with chest pain, evaluating for possible acute coronary syndrome (ACS) and WS is essential, as not undergoing timely intervention places patients at high risk of acute myocardial infarction (AMI). Case Report: A 45-year-old male patient presented with a complaint of intermittent chest pain for 10 days. ECG taken when the patient was actively experiencing chest pain revealed a biphasic T-wave in both leads V2 and V3 with normal cardiac serum biomarkers. During a pain-free period, another ECG revealed pseudo-normalization, which changed to deep inverted T waves in leads V1–V3 with elevated myocardial necrosis markers after 12 h. Non-ST-segment elevation myocardial infarction (NSTEMI) was considered, and coronary angiography (CAG) revealed 90% stenosis in the mid-LAD artery rather than in the proximal artery. Why should emergency physicians be aware of this?: WS is generally known for its characteristic T wave changes during a pain-free state. However, in this case, the patient presented with a biphasic T wave during active chest pain that changed to a deep inverted T wave when NSTEMI occurred. Therefore, clinician awareness of the characteristic ECG pattern changes is vital in preventing AMI and performing timely catheterization.
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