Atypical and delayed de Winter electrocardiograph pattern: A case report

Rationale: de Winter electrocardiograph (ECG) pattern signifies proximal left anterior descending coronary artery (LAD) occlusion and extensive anterior myocardial infarction, and it is found in about 2% of patients with proximal LAD occlusion. However, it is often unrecognized by physicians. In this case report, we present a patient with chest pain but showing an atypical and delayed de Winter ECG pattern. Patient concerns: A previously healthy 61-year-old man attended our emergency department with chest pain radiating to the left arm and back for 4 hours, who was without serious cardiovascular risk factors. ECG at emergency department showed no significant changes. High-sensitivity cardiac troponin I (hs-cTnI) was within normal limit. Diagnosis: At 5 hours after onset, ECG showed significant upsloping ST depression at J point in precordial leads V3 to V6, slight ST elevation in aVR and depression in inferior leads, and hs-cTnI peaked at 2.610 μg/L. The diagnosis of de Winter ECG pattern was confirmed by coronary angiography with an occlusion of the proximal LAD. Interventions: A stent was implanted through percutaneous coronary intervention. Outcomes: The patient's chest pain was relieved without further increase of hs-cTnI. ECG after procedure showed ST segment back to baseline in leads V4 to V6, but persistent ST elevation in V1 to V3 with QS or Q wave. Lessons: Timely diagnosis of de Winter ECG pattern is very important, especially the atypical an...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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