Volume 27, Issue 132, February 2023

An unusual case of organophosphate poisoning presenting Wellens or Pseudo- Wellens pattern: A diagnostic dilemma

Jeenat Khan^1♦, Akhilesh Singh Parihar², Gajanan Umalkar³, Charuta Gadkari⁴

¹Intern, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, India
²Senior Resident, Department of Emergency Medicine, Acharya Vinobha Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, India
³Junior Resident, Department of Emergency Medicine, Acharya Vinobha Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, India
⁴Professor, Department of Emergency Medicine, Acharya Vinobha Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, India

^♦Corresponding author
Intern, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, India

ABSTRACT

Organophosphate compounds such as Malathion, parathion, dimethoate, chlorpyrifos, tabun etc. Block the acetylcholinesterase enzyme, due to which acetylcholine levels increases. Organophosphate poisoning can occur after dermal, respiratory or oral exposure to organophosphate compounds. Respiratory symptoms are presented frequently in cases of organophosphate poisoning. Salivation, rhinorrhea along with bronchorrhea and bronchospasm are the muscarinic effects contributing to hypoxemia and increase in respiratory rate. Nicotinic effect causes muscular fragility and paralysis which may lead to respiratory failure. In wellens syndrome, the ECG reveals biphasic T waves or deep inverted T waves in leads V2-V3, indicating LAD stenosis, whereas Pseudo-Wellens have a Wellens ECG pattern but normal coronary architecture. In this case a 29-year-old male patient was brought from outside hospital with alleged history binge alcohol consumption and was found in unconscious state in his farm 2 days back.

Keywords: Wellens pattern, pseudo-wellens, LAD stenosis, alcohol, unconscious

Medical Science, 2023, 27, e96ms2726

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DOI: https://doi.org/10.54905/disssi/v27i132/e96ms2726

Published: 18 February 2023