When winter comes with all its might, so does the fright

A 57-year-old man with a personal history of arterial hypertension and overweight was referred from his primary care medical centre to our tertiary hospital reporting refractory typical chest pain lasting 3  h with persistent electrocardiogram (ECG) changes. The initial ECG (Panel A) showed: (i) atrial fibrillation with marked upsloping ST-segment depression; (ii) hyperacute T waves from leads V2 through V5, with a millimetric J point rise at lead aVR (De Winter sign, which was recently recognized as a ST-segment elevation equivalent). TheST ‐segment-elevation myocardial infarction network was activated and the patient was transferred immediately to the cath lab where a coronary angiography revealed total occlusion of the mid-left anterior descending coronary artery (Panel B). Percutaneous revascularization with placement of a drug-eluting stent was performed (Panel C). Sinus rhythm was restored spontaneously after coronary reperfusion (Panel D). The remaining hospitalization was uneventful. The precise mechanisms underlyingDe Winter pattern are still to be elucidated, and numerous hypotheses have been postulated to explain the absence of ST elevation, among others, (i) anatomic variations in the Purkinje system causing an intraventricular conduction delay; (ii) intermittent or incomplete coronary artery occlusion; (iii) existence of collateral blood supply protecting from transmural ischaemia; and (iv) lack of activation of the sarcolemmal adenosine triphosphate (ATP)-se...
Source: European Heart Journal - Category: Cardiology Source Type: research