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Wolff-Parkinson-White syndrome and de Winter patterns; An implication for paying special attention to
Mostafa Ahmadi1, Ramin Khameneh-Bagheri1, Mohammad Vojdanparast1
1Assistant Professor, Department of Cardiovascular Diseases, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
This report details the first documented case of de Winter ST-T wave pattern occurring in a patient with Wolff-Parkinson-White (WPW) syndrome. Physicians must carefully interpret ECG findings in WPW patients to avoid misdiagnosis of myocardial infarction.
Area of Science:
- Cardiology
- Electrocardiography
- Medical Case Reports
Background:
- Electrocardiography (ECG) remains crucial for diagnosing cardiac emergencies like myocardial infarction (MI).
- De Winter ST-T wave pattern is an ECG finding indicative of left anterior descending artery occlusion.
- Coexistence of de Winter pattern with other ECG abnormalities is rarely reported.
Background:
Despite recent advances in diagnostic techniques in cardiology, electrocardiography (ECG) has yet remained the first and corner stone of detecting emergency cardiac events including myocardial infarction (MI). There are some ECG findings which are considered as equivalents to MI. De Winter ST-T wave pattern is one of the important ECG findings which is thought to be related to left anterior descending artery occlusion. However, the coexistence of this ECG pattern with other ECG abnormalities are not reported widely. In this report, we discussed a unique case of de Winter ST-T wave pattern in a patient with Wolff-Parkinson-White (WPW) syndrome for the first time.
Case Report:
A 43-year-old man was referred because of an intermittent typical chest pain. The patient had no cardiovascular risk factor, and was not on any medication; laboratory tests showed elevated and raising troponin I. The first ECG showed pre-excitation (WPW) as well as de winter pattern. According to patient's symptoms and suggestive ECG for probable left anterior descending (LAD) occlusion, emergent angiography was scheduled. The coronary angiography revealed sever LAD artery occlusion. The patient was symptom free after successful percutaneous coronary intervention, and was discharged on medication. The patient remained asymptomatic in 1-year follow-up period.
Conclusion:
Presence of de Winter ST-T changes with other ECG abnormalities is a rare issue, and here we addressed the first case of WPW and de Winter. The physicians should be aware that ECG changes in patients with WPW should not be interpreted as de Winter ST-T changes and vice versa.
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