A 55-year-old man with a history of episodic chest pain at rest presents during a pain-free interval. ECG shows deep, symmetrical T-wave inversions in leads V2 and V3. Coronary angiography is planned. Which artery is most likely to have a critical stenosis?

• A Right coronary artery
• B Left circumflex artery
• C Left anterior descending artery ✓
• D Left main coronary artery

Explanation

Wellens syndrome indicates a critical stenosis of the proximal left anterior descending artery. It is characterized by deep, symmetrical T-wave inversions in V2 to V3 during a pain-free interval. RCA or LCx lesions typically present with inferior or lateral ECG changes. This is a pre-infarction state requiring urgent revascularization.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.