Chest pain is a very often complaint evaluated in the emergency department (ED). In addition to clinical assessment, electrocardiography (ECG) and cardiac biomarkers are used to evaluate the patient. 1 However, 2% to 4% persons who arrive with chest discomfort and acute myocardial infarction (AMI) are inappropriately discharged to home. This error in the diagnosis of MI is dangerous and costly. Early recognition and treatment are also important because time to treatment is the single most important factor in the management of AMI. 1 Wellens’ syndrome known as “LAD coronary T-wave syndrome” was first described in 1982 by Wellens and colleagues, who identified a subgroup of patients with unstable angina who had specific precordial T-wave changes and subsequently developed a large anterior wall MI. 2 Early recognition of this ECG abnormality is of para- mount importance because this syndrome represents a preinfarction stage of severe coronary artery dis- ease (CAD) that often progresses to a devastating an- terior wall MI. The characteristic ECG pattern of Wellens’ syndrome is relatively common in patients who have symptoms consistent with unstable angina. In studies performed by Dr. Wellens and colleagues, the ECG pattern was present in 14% to 18% of pa- tients admitted for unstable angina. 2 We herein report a case of Wellens’ syndrome but the patient could not be early diagnosed with acute coronary syndrome be- cause of normal troponin values in the first admis- sion. Turkiye Klinikleri J Case Rep. 2020;28(3):169-72 169 Troponin is Not Everything, a Difficult Diagnosis That Should be Kept in Mind: Wellens’ Syndrome Ömer Faruk KESKİN a , Mustafa DEMİR b a Gülhane Training and Research Hospital, Clinic of Cardiology, Ankara, TURKEY b Private Tekden Hospital, Clinic of Cardiology, Denizli, TURKEY ABSTRACT Chest pain is one of the most common problems evaluated in the emergency department (ED). In addition to physical examina- tion, electrocardiography (ECG) and cardiac biomarkers are often used in the initial assessment of patient in ED. Wellens’ syndrome is charac- terized by electrocardiographic T-wave changes especially in leads V2-V3 with severe proximal stenosis of the left anterior descending artery (LAD). We report a Wellens’ syndrome case which acute anterior myocardial infarction developed after 7 hours later since after the first emer- gency contact. It is important to rapidly and accurately risk-stratify patients with suspected acute coronary syndrome. Especially emergency physicians must be aware of negative T wave in leads V2-V3 on ECG and must know that only one normal troponin value alone does not ex- clude the diagnosis of acute coronary syndrome. It is very important to recognize Wellens’ syndrome early, as it allows rapid invasive interven- tion for cardiologist and cardiovascular surgery, so that extensive myocardial infarction can be prevented and perhaps a life can be saved. Keywords: Chest pain; acute anterior myocardial infarction; acute coronary syndromes DOI: 10.5336/caserep.2020-73456 CASE REPORT Correspondence: Ömer Faruk KESKİN Gülhane Training and Research Hospital, Clinic of Cardiology, Ankara, TURKEY E-mail: mstdemir@gmail.com Peer review under responsibility of Turkiye Klinikleri Journal of Case Reports. Received: 08 Jan 2020 Received in revised form: 09 Mar 2020 Accepted: 09 Mar 2020 Available online: 13 Mar 2020 2147-9291 / Copyright © 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Turkiye Klinikleri Journal of Internal Medicine Türkiye Klinikleri Journal of Case Reports