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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ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This is a case from many years ago that I discovered recently.  The patient has heart failure as a result of this event.A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chest pain, sharp, radiating down left arm, cramping, that waxes and wanes but never goes completely away.  There was SOB at the start and increased work of breathing.  He had been drinking 5 beers.  He does not seek medical attention often.  He called 911.  Medics recorded this ECG:There is a lot of artifact, but you can clearly see ST depression in V2 and V3....
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract Approximately 1% of primary care office visits are for chest pain, and 2% to 4% of these patients will have unstable angina or myocardial infarction. Initial evaluation is based on determining whether the patient needs to be referred to a higher level of care to rule out acute coronary syndrome (ACS). A combination of age, sex, and type of chest pain can predict the likelihood of coronary artery disease as the cause of chest pain. The Marburg Heart Score and the INTERCHEST clinical decision rule can also help estimate ACS risk. Twelve-lead electrocardiography is recommended to look for ST segment changes,...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
An elderly woman presented with 4 days of waxing and waning epigastric/substernal chest pain, worse on the day she presented.  She described the pain as a constant chest pressure, 6/10, without radiation to left arm, jaw or back, and without change in with breathing or movement.Here is her ED ECG:This was read as non-specific.  What do you think?I found this case while looking through a stack of ECGs, without clinical information.  I immediately thought " Acute LAD occlusion. "  Why?  There are QS-waves in V2-V4.  These suggest old anterior MI, or subacute MI.  But as ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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
A 75-year-old female patient presented to the emergency department with dyspnoea without chest pain. The personal history was significant for chronic obstructive pulmonary disease, smoking, and major depression. The electrocardiogram showed sinus tachycardia with ST elevations in V2 to V5 (Panel A). Clinical chemistry was significant for elevated N-terminal of prohormone brain natriuretic peptide (2892  ng/L), dynamic elevation of troponin T (baseline 21 ng/L, peak 78 ng/L), and normal creatine kinase. Echocardiography revealed left ventricular systolic dysfunction with reduced left ventricular ejectio...
Source: European Heart Journal - Category: Cardiology Source Type: research
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
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