Case Study: A Rare Presentation of Type A Wellens Syndrome in a 45-Year-Old Male with Type 2 Diabetes Mellitus and Systemic Hypertension.

Senthamarai

Charge Nurse, CCU, Kauvery Hospital, Alwarpet, Chennai

Abstract:

This case study presents a rare presentation of Type A Wellens syndrome in a 45-year-old male patient with Type 2 Diabetes Mellitus and Systemic Hypertension. The patient underwent successful PTCA stenting to proximal LAD and was managed for heart failure and adrenal insufficiency post-procedure. This case highlights the importance of timely recognition and intervention in patients with acute coronary syndrome.

Case Presentation:

A 45-year-old male was admitted to the CCU with a diagnosis of Type 2 Diabetes Mellitus and Systemic Hypertension. The patient presented with Cushingoid features, mature cataract in the right eye, and elevated blood pressure (180/90mmHg). An ECG revealed deep symmetric T-wave inversions in leads V2-V3, consistent with Type A Wellens syndrome.

Diagnosis:

– Type A Wellens syndrome

– Type 2 Diabetes Mellitus

– Systemic Hypertension

– Double Vessel Disease (90% Proximal LAD stenosis and CTO of RCA)

– Heart failure and adrenal insufficiency (post-procedure)

Symptoms:

– Elevated blood pressure

– Cushingoid features

– Mature cataract in the right eye

– Shortness of breath (post-procedure)

– Deep symmetric T-wave inversions in leads V2-V3 on ECG

Treatment Done:

– Loading doses of Ticagrelor, Aspirin, Atorvastatin, Nikoran, IV Heparin, and Inj. NTG infusion

– Coronary Angiogram on 21.04.25

– PTCA stenting to Proximal LAD using 4.0mm x 18mm XIENCE-SIERRA STENT

– Treatment for heart failure and adrenal insufficiency with Inj. Hydrocortisone, Inj. Lasix infusion, Inj. Digoxin, and BIPAP

Patient Discharge Instructions:

– Continue medications as prescribed

– Monitor blood pressure and blood sugar levels regularly

– Follow a healthy diet and exercise regimen

– Schedule follow-up appointments with the cardiologist and primary care physician

Feedback by Patient/Patient Family:

The patient and family expressed satisfaction with the care provided and thanked the healthcare team for their support and treatment.

Education:

The patient and family were educated on the importance of:

– Adhering to medication regimens

– Monitoring blood pressure and blood sugar levels

– Maintaining a healthy lifestyle

– Recognizing signs and symptoms of heart failure and adrenal insufficiency

Nursing Implications:

– Close monitoring of vital signs and cardiac status

– Administration of medications as prescribed

– Education on disease management and treatment

– Support and counseling for the patient and family

Conclusion:

This case study highlights the importance of timely recognition and intervention in patients with acute coronary syndrome, particularly those presenting with Type A Wellens syndrome. The patient’s successful recovery is attributed to the collaborative efforts of the healthcare team, including cardiologists, nurses, and other support staff. Early recognition and treatment of Type A Wellens syndrome can prevent significant morbidity and mortality.

Recommendations:

– Healthcare providers should be aware of the characteristic ECG findings of Type A Wellens syndrome.

– Patients presenting with Type A Wellens syndrome should undergo immediate coronary angiography and revascularization.

– Close monitoring and management of post-procedure complications, including heart failure and adrenal insufficiency, are crucial for optimal patient outcomes.

ECG At the time of Diagnosis

ECG After treatment

 

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