{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T03:07:59Z","timestamp":1770692879302,"version":"3.49.0"},"reference-count":48,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Twelve-lead electrocardiography (ECG) remains an essential diagnostic tool for patients presenting with chest pain. Timely recognition of specific electrocardiographic patterns is critical for guiding reperfusion strategies and predicting adverse outcomes. Among these, Wellens\u2019 pattern is a high-risk marker of critical left anterior descending (LAD) artery stenosis and an impending anterior myocardial infarction. Although typically described in clinically stable patients without heart failure, its occurrence in the setting of acute decompensation is rare. Case Report: We report the case of a 66-year-old male with hypertension, obesity, and active smoking who presented with exertional chest pain, dyspnea, and signs of acute heart failure. Initial ECG revealed biphasic T waves in V2\u2013V4, consistent with type A Wellens\u2019 pattern. Laboratory evaluation demonstrated elevated troponin I, while point-of-care ultrasound (POCUS) identified systolic and diastolic dysfunction, lateral wall hypokinesia, pericardial effusion, and cardiogenic pulmonary edema. The patient received acute management with antiplatelet therapy, statins, diuretics, and anticoagulation, followed by referral for coronary angiography. This revealed critical stenosis (&gt;90%) of the proximal LAD, successfully treated with percutaneous coronary intervention and drug-eluting stent implantation. The in-hospital course was uneventful, and guideline-directed medical therapy was optimized at discharge, including dual antiplatelet therapy, beta-blocker, renin\u2013angiotensin system inhibitor, and SGLT2 inhibitor. Conclusions: This case highlights the need for early recognition of Wellens\u2019 pattern, even in atypical contexts such as acute heart failure. Integrating ECG interpretation with bedside POCUS facilitated diagnostic accuracy and guided an early invasive strategy, preventing extensive myocardial infarction. In resource-limited settings, strengthening frontline diagnostic capabilities and referral networks is crucial to improving patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm14196982","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:07:48Z","timestamp":1759417668000},"page":"6982","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Integration of ECG and Point-of-Care Ultrasound in the Diagnosis of Wellens\u2019 Syndrome with Acute Heart Failure: A Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9959-3525","authenticated-orcid":false,"given":"Israel","family":"Silva","sequence":"first","affiliation":[{"name":"Ministerio de Salud P\u00fablica\u2014Centro de Salud, Valencia, Los Rios, 120610 Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Esteban","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Ministerio de Salud P\u00fablica\u2014Centro de Salud, San Antonio de Pichincha, Quito, 170102 Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5301-1866","authenticated-orcid":false,"given":"Andrea Cristina","family":"Arag\u00f3n","sequence":"additional","affiliation":[{"name":"Ministerio de Salud P\u00fablica\u2014Centro de Salud, Valencia, Los Rios, 120610 Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauricio Sebastian","family":"Moreno","sequence":"additional","affiliation":[{"name":"Ministerio de Salud P\u00fablica\u2014Centro de Salud, Lasso, Cotopaxi, 050102 Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Sofia","family":"Cepeda-Zaldumbide","sequence":"additional","affiliation":[{"name":"Ministerio de Salud P\u00fablica\u2014Centro de Salud, Lasso, Cotopaxi, 050102 Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camila","family":"Salazar-Santoliva","sequence":"additional","affiliation":[{"name":"One Health Research Group, Universidad de las Americas, Quito 170137, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4573-6217","authenticated-orcid":false,"given":"Jorge","family":"Vasconez-Gonzalez","sequence":"additional","affiliation":[{"name":"One Health Research Group, Universidad de las Americas, Quito 170137, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1178-0546","authenticated-orcid":false,"given":"Juan S.","family":"Izquierdo-Condoy","sequence":"additional","affiliation":[{"name":"One Health Research Group, Universidad de las Americas, Quito 170137, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1895-7498","authenticated-orcid":false,"given":"Esteban","family":"Ortiz-Prado","sequence":"additional","affiliation":[{"name":"One Health Research Group, Universidad de las Americas, Quito 170137, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"ref_1","first-page":"951","article-title":"High-Risk Electrocardiographic Patterns in Acute Myocardial Infarction: Early Recognition, Clinical Implications, and Therapeutic Decision-Making","volume":"5","author":"Martinez","year":"2025","journal-title":"Int. J. Med. Sci. Clin. Res. Stud."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e36335","DOI":"10.2196\/36335","article-title":"Intervention in the Timeliness of Two Electrocardiography Types for Patients in the Emergency Department With Chest Pain: Randomized Controlled Trial","volume":"11","author":"Yoo","year":"2022","journal-title":"Interact. J. Med. Res."},{"key":"ref_3","unstructured":"Basit, H., Malik, A., and Huecker, M.R. (2025). Non\u2013ST-Segment Elevation Myocardial Infarction. StatPearls, StatPearls Publishing."},{"key":"ref_4","first-page":"e31963","article-title":"Wellens Syndrome: A Possible Precursor","volume":"14","author":"Okobi","year":"2022","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"102094","DOI":"10.1016\/j.jaccas.2023.102094","article-title":"Progression From Patterns A to B in Wellens Syndrome","volume":"28","author":"Salva","year":"2023","journal-title":"JACC Case Rep."},{"key":"ref_6","first-page":"59","article-title":"A Classic Pattern of Wellens Syndrome on ECG: A Case Report","volume":"13","author":"Romero","year":"2023","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"135","DOI":"10.14740\/cr856","article-title":"Prevalence and Clinical Implication of Wellens\u2019 Sign in Patients With Non-ST-Segment Elevation Myocardial Infarction","volume":"10","author":"Kobayashi","year":"2019","journal-title":"Cardiol. Res."},{"key":"ref_8","unstructured":"Miner, B., Grigg, W.S., and Hart, E.H. (2025). Wellens Syndrome. StatPearls, StatPearls Publishing."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.ajem.2015.11.047","article-title":"The Electrocardiogram in the ACS Patient: High-Risk Electrocardiographic Presentations Lacking Anatomically Oriented ST-Segment Elevation","volume":"34","author":"Macias","year":"2016","journal-title":"Am. J. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.35366\/94774","article-title":"Wellens\u2019 Syndrome: Report and Review of a Case","volume":"31","year":"2020","journal-title":"Cardiovasc. Metab. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"110013","DOI":"10.1016\/j.mehy.2020.110013","article-title":"A Particular Case of Wellens\u2019 Syndrome","volume":"144","author":"Chioncel","year":"2020","journal-title":"Med. Hypotheses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.11604\/pamj-cm.2021.5.51.25074","article-title":"Wellens\u00b4 Syndrome: About Two Cases","volume":"5","author":"Lassoued","year":"2021","journal-title":"PAMJ Clin. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e930125-1","DOI":"10.12659\/AJCR.930125","article-title":"A 75-Year-Old Woman with COVID-19 Pneumonia and Wellens Syndrome Diagnosed by Electrocardiography","volume":"22","author":"Prousi","year":"2021","journal-title":"Am. J. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1016\/j.hrthm.2011.04.035","article-title":"Myocardial Edema Underlies Dynamic T-Wave Inversion (Wellens\u2019 ECG Pattern) in Patients with Reversible Left Ventricular Dysfunction","volume":"8","author":"Migliore","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"8865553","DOI":"10.1155\/2023\/8865553","article-title":"Characteristics of Wellens\u2019 Syndrome in the Current PCI Era: A Single-Center Retrospective Study","volume":"2023","author":"Zhou","year":"2023","journal-title":"Emerg. Med. Int."},{"key":"ref_16","unstructured":"(2025, September 23). CARE Case Report Guidelines. Available online: https:\/\/www.care-statement.org."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00134-012-2513-4","article-title":"International Evidence-Based Recommendations for Point-of-Care Lung Ultrasound","volume":"38","author":"Volpicelli","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1378\/chest.07-2800","article-title":"Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure: The BLUE Protocol","volume":"134","author":"Lichtenstein","year":"2008","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.ajem.2014.01.045","article-title":"E-Point Septal Separation: A Bedside Tool for Emergency Physician Assessment of Left Ventricular Ejection Fraction","volume":"32","author":"McKaigney","year":"2014","journal-title":"Am. J. Emerg. Med."},{"key":"ref_20","first-page":"3","article-title":"The Use of Echocardiography in Acute Cardiovascular Care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association","volume":"4","author":"Lancellotti","year":"2015","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr. Off. Publ. Am. Soc. Echocardiogr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jsha.2010.10.001","article-title":"The Clinical Significance of Cardiac Troponins in Medical Practice","volume":"23","year":"2011","journal-title":"J. Saudi Heart Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1378\/chest.125.5.1877","article-title":"Common Causes of Troponin Elevations in the Absence of Acute Myocardial Infarction: Incidence and Clinical Significance","volume":"125","author":"Roongsritong","year":"2004","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"601","DOI":"10.2147\/VHRM.S327661","article-title":"The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis","volume":"17","author":"Chauin","year":"2021","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_25","first-page":"394","article-title":"La placa aterog\u00e9nica: Fisiopatolog\u00eda y consecuencias cl\u00ednicas","volume":"40","year":"2002","journal-title":"Med. Integral"},{"key":"ref_26","first-page":"504","article-title":"Obesity and Obesity-Induced Inflammatory Disease Contribute to Atherosclerosis: A Review of the Pathophysiology and Treatment of Obesity","volume":"11","author":"Henning","year":"2021","journal-title":"Am. J. Cardiovasc. Dis."},{"key":"ref_27","first-page":"326","article-title":"La diabetes y la alimentaci\u00f3n determinantes en la progresi\u00f3n de aterosclerosis","volume":"86","year":"2016","journal-title":"Arch. Cardiol. M\u00e9xico"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Poznyak, A.V., Sadykhov, N.K., Kartuesov, A.G., Borisov, E.E., Melnichenko, A.A., Grechko, A.V., and Orekhov, A.N. (2022). Hypertension as a Risk Factor for Atherosclerosis: Cardiovascular Risk Assessment. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.959285"},{"key":"ref_29","first-page":"7718","article-title":"Wellens Syndrome without Chest Pain, Is It Possible?","volume":"24","author":"Torelli","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_30","first-page":"787","article-title":"Wellens syndrome: A high-risk electrocardiographic pattern","volume":"82","author":"Rotondaro","year":"2022","journal-title":"Medicina"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"bcr2012008513","DOI":"10.1136\/bcr-2012-008513","article-title":"Wellens\u2019 Syndrome: A Classical Electrocardiographic Sign of Impending Myocardial Infarction","volume":"2013","author":"Singh","year":"2013","journal-title":"BMJ Case Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"03000605251324480","DOI":"10.1177\/03000605251324480","article-title":"Advances in the Study of Wellens Syndrome","volume":"53","author":"Zhang","year":"2025","journal-title":"J. Int. Med. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/0002-8703(89)90742-4","article-title":"Angiographic and Clinical Characteristics of Patients with Unstable Angina Showing an ECG Pattern Indicating Critical Narrowing of the Proximal LAD Coronary Artery","volume":"117","author":"Janssen","year":"1989","journal-title":"Am. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e41176","DOI":"10.1097\/MD.0000000000041176","article-title":"Dangerousness: T-Wave Pseudonormalization in a Patient with Wellens\u2019 Syndrome: A Case Report","volume":"103","author":"Lei","year":"2024","journal-title":"Medicine"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Venkatayogi, N., Gupta, M., Gupta, A., Nallaparaju, S., Cheemalamarri, N., Gilari, K., Pathak, S., Vishwanath, K., Soney, C., and Bhattacharya, T. (2023). From Seeing to Knowing with Artificial Intelligence: A Scoping Review of Point-of-Care Ultrasound in Low-Resource Settings. Appl. Sci., 13.","DOI":"10.3390\/app13148427"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Nati-Castillo, H.A., Saavedra T., J.S., Valderrama, L.A., Ortiz-Prado, E., and Izquierdo-Condoy, J.S. (2025). Point-of-Care Ultrasound (POCUS) as a Key Tool in the Diagnosis of Pheochromocytoma: A Case Report in an Elderly Patient with Extreme Blood Pressure Variability. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1525893"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.recesp.2011.10.027","article-title":"Insuficiencia Cardiaca En El Infarto Agudo de Miocardio: Comparaci\u00f3n de Pacientes Con o Sin Criterios de Insuficiencia Cardiaca Del Registro FAST-MI","volume":"65","author":"Cambou","year":"2012","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Writing Committee Members, Lawton, J.S., Tamis-Holland, J.E., Bangalore, S., Bates, E.R., Beckie, T.M., Bischoff, J.M., Bittl, J.A., Cohen, M.G., and DiMaio, J.M. (2022). 2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization. JACC, 79, e21\u2013e129.","DOI":"10.1016\/j.jacc.2021.09.006"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_41","first-page":"e362","article-title":"2013 ACCF\/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"127","author":"Kushner","year":"2013","journal-title":"Circulation"},{"key":"ref_42","first-page":"78","article-title":"Pharmaco-Invasive Strategy Vs Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Latin America: A Meta-Analysis","volume":"7","author":"Costabel","year":"2024","journal-title":"CJC Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1159\/000455911","article-title":"Wellens\u2019 Syndrome: A Bad Omen","volume":"137","author":"Luiz","year":"2017","journal-title":"Cardiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e771","DOI":"10.1161\/CIR.0000000000001328","article-title":"2025 ACC\/AHA\/ACEP\/NAEMSP\/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"151","author":"Rao","year":"2025","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Tan, J., Liao, X., Tan, T., Li, X., and Tan, H. (2024). Wellen\u2019s Syndrome Caused by Severe Ostial Stenosis of the Left Main Coronary Artery: A Case Report. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-04365-1"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e230421189013","DOI":"10.2174\/1573403X16999201210195702","article-title":"Myocardial Infarction with and without ST-Segment Elevation: A Contemporary Reappraisal of Similarities and Differences","volume":"17","author":"Mitsis","year":"2021","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Mach, F., Koskinas, K.C., Roeters van Lennep, J.E., Tokg\u00f6zo\u011flu, L., Badimon, L., Baigent, C., Benn, M., Binder, C.J., Catapano, A.L., and De Backer, G.G. (2025). 2025 Focused Update of the 2019 ESC\/EAS Guidelines for the Management of Dyslipidaemias: Developed by the Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur. Heart J., ehaf190.","DOI":"10.1016\/j.atherosclerosis.2025.120479"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6982\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:27:28Z","timestamp":1759418848000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6982"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,2]]},"references-count":48,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196982"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196982","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,2]]}}}