A rare transitory change of the De Winter ST/T-wave complex in a patient with cardiac arrest: A case report
1Department of Cardiology of Hankou District of the General Hospital of Central Theatre Command of PLA.
Insights
The De Winter ST/T-wave complex, a rare ECG finding indicating proximal LAD occlusion, can transiently change, mimicking STEMI. This case highlights its dangerous, evolving nature and the need for prompt intervention.
Area of Science:
- Cardiology
- Emergency Medicine
- Electrocardiography
Background:
- The De Winter ST/T-wave complex is a rare electrocardiogram (ECG) finding associated with proximal left anterior descending (LAD) coronary artery occlusion.
- It typically presents as ST-segment depression, not ST-elevation, and its transient nature has not been previously documented.
Observation:
- A patient presented with chest pain and loss of consciousness, initially showing ST-elevation myocardial infarction (STEMI) on ECG.
- A subsequent ECG, taken 22 minutes later after resuscitation, revealed a De Winter ST/T-wave complex, indicating acute anterior-wall myocardial infarction.
Findings:
- The patient was diagnosed with acute myocardial infarction and successfully treated with percutaneous coronary intervention (PCI).
- The case confirmed a transient change in the De Winter ST/T-wave complex, a previously unreported phenomenon.
Implications:
- The De Winter ST/T-wave complex is a critical, though not widely recognized, ECG manifestation signifying a high risk of acute myocardial infarction due to proximal LAD occlusion.
- This case underscores the importance of recognizing dynamic ECG changes and considering the De Winter complex as a STEMI equivalent, necessitating urgent management.
Rationale:
The De Winter ST/T-wave complex is a rare and special electrocardiogram (ECG) manifestation in some patients with a total or subtotal occlusion in the proximal left anterior descending (LAD) coronary artery. It mainly appears as an ST-segment superior oblique depression instead of an ST elevation. However, a transitory change of the De Winter ST/T-wave complex has not been reported previously.
Patient Concerns:
A 40-year-old man developed sudden precordial dull and unrelieved pain. One hour later, he suddenly lost consciousness when he arrived at the emergency department. After successful cardiopulmonary resuscitation (CPR), 2 ECGs were taken at 22-minute interval, which showed completely different manifestations. The first ECG showed acute inferior-wall ST elevation myocardial infarction (STEMI), while the second ECG showed a De Winter ST/T-wave complex, which indicated acute anterior-wall myocardial infarction.
Diagnosis:
The patient was diagnosed with acute myocardial infarction.
Interventions:
The patient responded to urgent treatment by percutaneous coronary intervention (PCI).
Outcomes:
It was confirmed that the case was consistent with the main characteristics of a De Winter ST/T-wave complex after PCI. The first ECG was a rare transitory change of the De Winter ST/T-wave complex. The patient was well recovered and discharged.
Lessons:
The De Winter ST/T-wave complex is an extremely dangerous and rare ECG manifestation that is not widely recognized at present. Although the mechanism is not very clear, it should be considered as indicating an equivalent risk of STEMI because it may suggest total or subtotal occlusion in the proximal LAD coronary artery. It is believed that in the near future, the mechanism of ECG including its transitory changes, will be fully revealed.
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