Wellens-like ECG pattern without LAD disease: Diagnostic value of early cardiac MRI

Takotsubo syndrome (TTS) can mimic acute coronary syndrome, including rare Wellens-like ECG patterns. We report a case of a 70-year-old woman with hypertension, dyslipidemia, and depression presenting with transient paresthesia, stress-related chest heaviness and biphasic anterior T-wave changes initially suggestive of proximal LAD disease. Coronary angiography performed 14 hours after admission revealed unobstructed arteries. Early cardiac MRI performed 48 hours after symptom onset demonstrated mid-ventricular hypokinesis with apical akinesis, basal sparing, an apico-basal edema gradient on T2-weighted imaging, elevated native T1 and extracellular volume toward the apex, left-ventricular ejection fraction 40%, and no late gadolinium enhancement. This case underscores the importance of early cardiac MRI in differentiating TTS from obstructive coronary disease and other MINOCA etiologies.