The de Winter electrocardiogram pattern in a 52-year-old-male: a case report
Matthew Di Toro1, Stephen Weissbacher1, Jarrod Wakeling1
1Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia.
Insights
The de Winter ECG pattern, a critical indicator of acute myocardial infarction (MI) without ST-segment elevation, requires prompt recognition by medical professionals for timely intervention and improved patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- The 12-lead electrocardiogram (ECG) is crucial for diagnosing acute myocardial infarction (MI) based on ST-segment elevation.
- The de Winter ECG pattern, an important MI indicator, lacks ST-segment elevation and may be overlooked.
Purpose of the Study:
- To highlight the de Winter ECG pattern as a critical diagnostic finding in acute myocardial infarction (MI).
- To emphasize the importance of recognizing non-ST-elevation ECG patterns in emergent cardiac care.
Main Methods:
- Case report presentation of a patient with acute MI and the de Winter ECG pattern.
- Review of diagnostic criteria and treatment protocols for acute myocardial infarction.
Main Results:
- A patient presenting with chest pain was diagnosed with acute MI despite lacking standard ST-elevation myocardial infarction (STEMI) criteria.
- The de Winter ECG pattern was identified, leading to immediate percutaneous coronary intervention and successful treatment.
Conclusions:
- Acute MI can present with ECG findings not meeting STEMI criteria, such as the de Winter pattern.
- Immediate recognition of the de Winter ECG pattern by paramedics, physicians, and catheterization lab staff is vital for prompt reperfusion therapy.
Background:
The 12-lead electrocardiogram (ECG) remains the primary test for diagnosis of acute myocardial infarction (MI) secondary to acute coronary occlusion or near occlusion, with insufficient collateral circulation. Decisions regarding urgent reperfusion are based on whether or not there's new ST-segment elevation. The de Winter ECG pattern is a distinct ECG pattern without any ST-segment elevation, it may be missed by anyone unfamiliar with it.
Case Summary:
We present a case whose chief complaint was severe central chest pain, the patient was diagnosed with acute MI secondary to a culprit lesion in the left anterior descending artery, despite the ECG not meeting standard STEMI criteria. After the ECG's significance was recognized by paramedics, the patient received immediate percutaneous coronary intervention with stenting and was discharged home after a brief hospital admission.
Discussion:
In some cases, acute MI presents with ECG features that do not meet the standard criteria for STEMI diagnosis. The de Winter ECG pattern is one such example. This pattern should be immediately recognizable to those responsible for the activation of the catheterization laboratory, physicians, and paramedics included.
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