The diagnosis of acute coronary syndrome relies on clinical history, 
electrocardiographic (ECG) changes, and cardiac biomarkers; but within the 
spectrum of acute coronary syndrome, there exist subtle presentations that 
cannot afford to be overlooked. Wellens syndrome is one such example, in which a 
patient can present with both ECG changes that are not classic for myocardial 
ischemia and negative cardiac biomarkers. The characteristic ECG findings 
associated with Wellens syndrome consist of deep, symmetric T-wave inversions in 
the anterior precordial leads. However, Wellens syndrome can also present as 
biphasic T-wave inversions in those same ECG leads. The associated critical 
stenosis of the proximal left anterior descending artery carries an immediately 
life-threatening prognosis if not recognized promptly (Am Heart J. 1982;103[4 Pt 
2]:730-736). We describe a case of a less common manifestation of Wellens 
syndrome (type 1) followed by a discussion of its implications and management.