We report the case of a woman in her 70s presenting to the emergency department 
with syncope, troponemia, and an electrocardiogram with deep symmetric T-wave 
inversions in V2 and V3 and prolonged QTc. Her presentation was concerning for 
acute coronary syndrome, Wellens syndrome in particular, given the elevated 
troponin levels, lack of ST segment changes, and characteristic T-wave findings. 
The diagnosis was confirmed with angiography that showed a critical left 
anterior descending (LAD) artery occlusion. Since myocardial infarction does not 
typically present with syncope, we explored the differential diagnoses for 
T-wave inversions, which include electrolyte abnormalities, medications, 
intracranial hemorrhage, pulmonary embolism, and other cardiac diseases that 
were ruled out in our patient. We also explored the pathophysiology leading to 
syncope in the setting of acute myocardial infarction including arrhythmias and 
exaggerated neurally mediated response. Our patient received two drug-eluting 
stents to the LAD artery and was started on dual antiplatelet therapy, 
beta-blockers, and an angiotensin-converting enzyme inhibitor.