American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2019, 7(11), 297-300
DOI: 10.12691/ajmcr-7-11-9
Open AccessArticle

Wellens’ Syndrome in a HIV-positive Patient: A Case Report

Pramod Theetha Kariyanna1, Denis Yusupov1, Benjamin Ramalanjaona1, Apoorva Jayarangaia2, Mohammed Al-Sadawi1 and Isabel. M. McFarlane1,

1Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203

2Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, N.Y., U.S.A- 10461

Pub. Date: September 06, 2019

Cite this paper:
Pramod Theetha Kariyanna, Denis Yusupov, Benjamin Ramalanjaona, Apoorva Jayarangaia, Mohammed Al-Sadawi and Isabel. M. McFarlane. Wellens’ Syndrome in a HIV-positive Patient: A Case Report. American Journal of Medical Case Reports. 2019; 7(11):297-300. doi: 10.12691/ajmcr-7-11-9


Patients with human immunodeficiency virus (HIV) are at higher risk for coronary artery disease, due to accelerated atherosclerosis resulting from chronic inflammation, the prevalence of cardiovascular risk factors and the side effects of highly active antiretroviral therapy (HAART). The Wellens’ pattern is an electrocardiographic (ECG) finding that represents critical proximal left anterior descending (LAD) coronary artery stenosis that, that when is not promptly treated, can lead to extensive anterior wall myocardial infarction and death. Very few cases of Wellens’ syndrome in HIV positive patients have been reported. We present a case of Wellens’ syndrome in a 38-year-old male with HIV on HAART and hyperlipidemia, as his only traditional cardiovascular risk factor. Recognition of the characteristic biphasic T-waves in V2 and V3 on ECG in the setting of typical angina and elevated troponin levels directed the clinicians to proceed with an emergent cardiac catheterization and percutaneous coronary intervention with drug eluting stent placement in the proximal left anterior descending artery (LAD). Physicians should recognize Wellens’ syndrome as it indicates critical LAD stenosis requiring intervention. HIV positive patients can present with Wellens’ sign at a younger age, indicating premature coronary artery disease (CAD) in this population.

human immunodeficiency virus HIV Wellens syndrome premature coronary artery disease biphasic T-waves chronic inflammation critical left anterior descending stenosis dyslipidemia

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[1]  Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. The American journal of emergency medicine. 2002 Nov 1; 20(7): 638-43.
[2]  de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. American heart journal. 1982 Apr 1; 103(4): 730-6.
[3]  de Zwaan C, Bär FW, Janssen JH, Cheriex EC, Dassen WR, Brugada P, Penn OC, Wellens HJ. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. American heart journal. 1989 Mar 1; 117(3): 657-65.
[4]  Feinstein MJ, Bahiru E, Achenbach C, Longenecker CT, Hsue P, So-Armah K, Freiberg MS, Lloyd-Jones DM. Patterns of cardiovascular mortality for HIV-infected adults in the United States: 1999 to 2013. The American journal of cardiology. 2016 Jan 15; 117(2): 214-20.
[5]  Triant VA, Regan S, Lee H, Sax PE, Meigs JB, Grinspoon SK. Association of immunologic and virologic factors with myocardial infarction rates in a US healthcare system. J Acquir Immune Defic Syndr. 2010; 55(5): 615-9.
[6]  Currier JS, Lundgren JD, Carr A, Klein D, Sabin CA, Sax PE, Schouten JT, Smieja M Working Group 2. Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy. Circulation. 2008; 118: e29–e35.
[7]  Di Stolfo G, Mastroianno S, De Luca G, Potenza DR, Marchese N, Vigna C, Fanelli R. A Silent Alarm at Occupational Evaluation Two Months after a Normal Painful ECG: A Case of Wellens’ syndrome. Case reports in cardiology. 2015; 2015.
[8]  Tan B, Morales-Mangual C, Zhao D, Khan A, Chadow H. Wellens syndrome in HIV-infected patients: Two case reports. Medicine. 2017 Jun; 96(24).
[9]  Al-Adwan S, Montesano P, Easwar A, Wang X, Duvall W. ALL’S WELL (EN) THAT ENDS WELL: A YOUNG LAD WITH WELLEN SYNDROME. Chest. 2018 Oct 1; 154(4).
[10]  Post WS, Budoff M, Kingsley L, et al. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med. 2014; 160(7): 458-467.
[11]  Cerrato E, D'Ascenzo F, Biondi-Zoccai G, et al. Acute coronary syndrome in HIV patients: from pathophysiology to clinical practice. Cardiovasc Diagn Ther. 2012; 2(1): 50-55.
[12]  Feinstein MJ, Lloyd-Jones DM. Macrophage Inflammation and Cardiovascular Disease in HIV: Mechanistic Insights and Future Directions. J Infect Dis. 2017; 215(9): 1343-1345.
[13]  Abdulrahman Abutaleb MMJF, MD. Coronary Artery Disease in HIV. 2018. Accessed May 27th, 2019.
[14]  Carr A, Samaras K, Burton S, et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS. 1998; 12(7): F51-58.
[15]  Drozd DR, Kitahata MM, Althoff KN, et al. Increased Risk of Myocardial Infarction in HIV-Infected Individuals in North America Compared With the General Population. J Acquir Immune Defic Syndr. 2017; 75(5): 568-576.
[16]  Pearce D, Ani C, Espinosa-Silva Y, Clark R, Fatima K, Rahman M, Diebolt E, Ovbiagele B. Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive versus sero-negative individuals. Am J Cardiol. 2012; 110: 1078-1084.
[17]  High KP, Brennan-Ing M, Clifford DB, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr. 2012; 60 Suppl 1(Suppl 1): S1-S18.
[18]  Barrabés JA, Galian L. Endogenous thrombolysis: a hidden player in acute coronary syndromes?