Anesthetic management of life-threatening hemorrhagic shock in a patient with Wellens' syndrome: A case report

Wellens' syndrome, characterized by pathognomonic precordial T-wave inversions (V2–V4) signifying critical proximal left anterior descending (LAD) coronary artery stenosis, represents a high-risk form of unstable angina requiring urgent revascularization. We detail the challenging anesthetic management of a 50-year-old male who presented with hemorrhagic shock secondary to a splenic laceration following blunt abdominal trauma. Wellens' syndrome was concurrently diagnosed on the admission electrocardiogram. The critical management decision prioritized emergency splenectomy to control active, life-threatening hemorrhage over immediate coronary intervention. Anesthetic care focused on maintaining meticulous hemodynamic stability, optimizing the myocardial oxygen supply-demand balance, and minimizing cardiovascular depression during a modified rapid sequence induction utilizing etomidate and fentanyl. The patient successfully underwent splenectomy under general anesthesia, followed by urgent percutaneous coronary intervention (PCI) on postoperative day 2. Ultimately, this case demonstrates that navigating the high-stakes trade-off between fatal exsanguination and impending myocardial infarction requires a decisive hierarchy of clinical interventions and a tailored anesthetic strategy to balance these two competing, life-threatening emergencies.