Abstract
BackgroundDe Winter pattern is associated with acute occlusion in the left anterior descending coronary artery combined with upsloping ST-segment depression at the J point in leads V1 through V6 without ST-segment elevation. The ECG changes in this case were illustrated by an up-sloping ST-segment depression in the V1 to V6 leads, followed by tall and symmetrical T waves. Changes from de Winter to ST-segment elevation myocardial infarction (STEMI) are rare.Case presentationOur case illustrated an evolutionary de Winter sign that changed to STEMI; the patient underwent cardiac catheterization in time.ConclusionsPatients who have an electrocardiogram showing de Winter changes may require primary percutaneous coronary intervention. Emergency physicians and cardiologists should not ignore these changes.
Highlights
De Winter pattern is associated with acute occlusion in the left anterior descending coronary artery combined with upsloping ST-segment depression at the J point in leads V1 through V6 without ST-segment elevation
The main characteristics of the de Winter electrocardiogram (ECG) pattern are up-sloping ST-segment depression in the V1 to V6 leads, followed by tall and symmetrical T waves [1], which remain consistent with no evolutionary ECG changes
We present a patient with acute proximal left anterior descending (LAD) occlusion who presented with an evolutionary ECG change in which the de Winter ST-T changes evolved into ST-segment elevation myocardial infarction (STEMI)
Summary
Acute subtotal or total proximal left anterior descending (LAD) occlusion can present de Winter ST-T changes. The main characteristics of the de Winter electrocardiogram (ECG) pattern are up-sloping ST-segment depression in the V1 to V6 leads, followed by tall and symmetrical T waves [1], which remain consistent with no evolutionary ECG changes. We present a patient with acute proximal LAD occlusion who presented with an evolutionary ECG change in which the de Winter ST-T changes evolved into ST-segment elevation myocardial infarction (STEMI). Case presentation A 31-year-old male with no medical history presented to the emergency department with persistent chest pain for 1 h. The first ECG (finished in the ambulance) revealed up-sloping ST-segment depression in the V2 to V6 leads,
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