De Winter syndrome as an emergency electrocardiogram sign of ST ‐elevation myocardial infarction: a case report

We report a case of a 49‐year‐old man with a history of smoking who presented to the emergency department with a 1 day history of chest pain that was exacerbated 5 h prior to presentation. Detailed clinical investigations and coronary angiogr aphic characteristics were recorded. The first ECG of the patient was consistent with de Winter syndrome. Acute coronary artery angiography showed that the proximal left anterior descending coronary artery was completely occluded after the first diagonal branch artery was given off. A percutaneous c oronary intervention was immediately performed. Our case indicates that early identification and diagnosis of such ECGs and timely reperfusion therapy of de Winter syndrome as a STEMI equivalent are required to improve the prognosis of such patients.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Case Report Source Type: research

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A ~40 year old woman started having chest discomfort.  She called 911 after an uncertain amount of time.  EMS arrived and recorded thisprehospital ECG:Obvious Anterior and Inferior STEMI, consistent with LAD occlusionAfter recording this ECG, the patient went intoventricular fibrillation.She was rapidly defibrillated.The cath lab was activated by the paramedics.She arrived complaining of chest pain, with a BP of 110/70.An ED ECG was recorded:It looks worse stillAside: Should the patient receive antidysrhythmics to prevent recurrent VT/VF?  See discussion below on both beta blockers and other anti-dysrhythmic...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
We report a patient with mild carbon monoxide poisoning who had acute dyspnea as the earliest symptom and was later diagnosed with non-ST elevation myocardial infarction (NSTEMI) and acute left heart failure. Patient concerns: A 73-year-old woman complained of dizziness and fatigue with shortness of breath after carbon monoxide intoxication. Diagnoses: This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads in the chest, card...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
AbstractEvaluation of atypical presentation of angina chest pain in emergency department is difficult. Hospitalization of this patient may impose additional costs and waste the time, early discharge may lead to miss the patients. The aim of this study was to determine volubility of Single Photon Emission Computed Tomography (SPECT) in management of patients admitted to emergency department with atypical manifestations of angina pain, un-diagnostic Electrocardiogram (ECG) and negative enzyme. Half of 100 patients admitted to emergency department with atypical chest pain and un-diagnostic ECG who were candidate for admission...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
This study is unable to comment on whether patients with STEMI(-) Occlusion MI have benefit from emergent cath, because that is not the population studied and this subgroup is not commented on.This study is just the most recent in a long long line of similar literature. Context is everything for understanding this study. See below for an excerpt from theOMI Manifesto which summarizes the existing literature and provides details on each study:-------------------------------------------------------------------------------------------------------------- Counter-argument:“Haven’t there been RCTs showing no benefit ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This report describes a case of MINOCA patient suffered with multiple complications. Patient concerns: A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads. Diagnosis: Emergency coronary artery angiogram no significant coronary artery stenosis being observed. The diagnosis of MINOCA was established. She subsequently developed ventricular thrombus, heart failure, and ventricular arrhythmia. Interventions: The patient's ventricular tachycardia (VT) was refractory to different treatments. Due to the presence of ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion: "Given the extremely low yield and high associated charges, current guidelines for triage ECG for identifying a possible STEMI should be reviewed. "Fair enough.  I will briefly review the guidelines here and now: One should never use charges to calculate cost.  Charges and cost have no relation to each other in hospital billing.  In our ED, a health care assistant (HCA) records all ECGs, in triage and elsewhere.  It takes at most 10 minutes (this is an exaggeration).  At total compensation of $50,000 per year, working 1800 hours, an HCA could record over 10,000 ECGs ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
By ANISH KOKA, MD I’m sitting amidst a number of cardiologists to go over the most recent trials presented at the interventional cardiology conference in Denver.  The cardiology fellow presenting goes quickly through the hors de oeuvres until finally getting to the main course – ORBITA. ORBITA sought to test the very foundations interventional cardiology was built on – the simple idea that opening a stenosed coronary artery was good for patients.  The trial was a double blind randomized control trial of patients with tightly stenosed arteries who either had a stent placed or had a sham procedure...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Anish Koka cardiology Orbita Source Type: blogs
A middle-aged male with several comorbidities including DM presented with chest pain.  It had been on and off all day, then constant for 2.5 hours.  It was central without radiation, sharp but also tight, and was 9/10.   There was some cough, but no SOB; he reports COPD and has been using his inhalers without improvement. He also reports diaphoresis and tingling of his hands since the worsening of pain at 1700.His BP was 160/90.He was given aspirin and nitro via EMS with good improvement in his chest pain.First ED ECG at 2:40 after chest pain became severe.Sinus rhythm.Slight left axis deviation (mostly...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Conclusion This valuable audit looks at nine years' worth of data from NHS hospitals, finding about a third of people with two forms of heart attack – STEMI and NSTEMI – are often wrongly diagnosed initially. These people are less likely to receive the guideline-indicated treatments they need – and the delay in receiving correct treatment could have a harmful effect. The study also highlights the factors associated with a wrong diagnosis, including being of an older age, having heart failure, and atypical findings for either diagnosis. Unexpectedly, gender was also associated with a wrong initial diagnos...
Source: NHS News Feed - Category: Consumer Health News Tags: Heart/lungs Medical practice Source Type: news
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