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Atypical and delayed de Winter electrocardiograph pattern: A case report.

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The de Winter electrocardiograph (ECG) pattern, often missed, indicates critical coronary artery blockage. Prompt recognition and treatment are vital for patients with this ST elevation myocardial infarction equivalent.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Electrocardiography

Background:

  • The de Winter electrocardiograph (ECG) pattern is a rare but critical sign of proximal left anterior descending (LAD) coronary artery occlusion.
  • This ECG finding, present in approximately 2% of proximal LAD occlusion cases, is frequently underrecognized by clinicians.
  • This case highlights an atypical and delayed presentation of the de Winter ECG pattern.

Observation:

  • A 61-year-old man presented with acute chest pain and initially non-diagnostic ECG changes.
  • Serial ECG monitoring revealed evolving ST depression in precordial leads (V3-V6) and ST elevation in aVR, characteristic of the de Winter pattern.
  • Cardiac biomarkers (hs-cTnI) showed a significant rise, confirming myocardial injury.

Findings:

  • Coronary angiography confirmed a critical occlusion in the proximal LAD.
  • Percutaneous coronary intervention with stent implantation successfully restored blood flow.
  • Post-intervention, chest pain resolved, and ECG changes partially normalized, though persistent anterior ST changes were noted.

Implications:

  • The de Winter ECG pattern should be recognized as a STEMI equivalent, necessitating urgent reperfusion therapy.
  • Timely diagnosis, even with atypical or delayed ECG manifestations, is crucial for optimal patient outcomes.
  • This case underscores the importance of vigilant ECG interpretation in patients with acute chest pain syndromes.