The de Winter ECG Pattern in the Absence of Acute Coronary Artery Occlusion

Area of Science:

• Cardiology
• Diagnostic Electrocardiography

Background:

• The de Winter electrocardiogram (ECG) pattern is a rare finding associated with acute myocardial infarction.
• Limited data exists on the diagnostic utility of this specific ECG pattern.

Observation:

• A 26-year-old male presented with chest pain and de Winter ECG findings.
• Coronary angiography ruled out significant coronary artery stenosis.
• Cardiac MRI confirmed myocarditis.

Findings:

• The case highlights the uncertainty surrounding the de Winter ECG pattern's positive predictive value for acute myocardial infarction.
• Myocarditis was diagnosed despite the initial ECG suspicion of acute myocardial infarction.

Implications:

• The de Winter ECG pattern should be treated as an ST-elevation myocardial infarction equivalent in suspected ischemia cases.
• Further prospective studies are needed to establish the definitive role of the de Winter ECG pattern in diagnosing acute coronary syndromes.