Atypical de Winter ECG pattern may be the mirror image of ST elevation

Area of Science:

• Cardiology
• Electrocardiography
• Myocardial Infarction

Background:

• The de Winter electrocardiogram (ECG) pattern, characterized by ST-segment depression and tall symmetrical T waves, is recognized as an ST elevation equivalent.
• This pattern typically signifies occlusion of the proximal left anterior descending (LAD) coronary artery, accounting for about 2% of such cases.
• While classically associated with non-ST elevation, mixed presentations with varying ST deviations have been documented.

Observation:

• This report details a unique case presenting as an ST elevation myocardial infarction (STEMI) equivalent.
• The patient exhibited transient transmural ischemia affecting the inferolateral myocardium.
• The observed ECG changes closely mimicked the de Winter pattern.

Findings:

• The case demonstrates that the de Winter pattern can be associated with STEMI equivalents.
• Transient inferolateral ischemia can manifest with ECG findings resembling the de Winter pattern.
• This challenges the traditional exclusion of ST elevation in the de Winter pattern definition.

Implications:

• Recognizing STEMI equivalents with de Winter-like ECG changes is crucial for timely diagnosis and treatment.
• This case expands the understanding of ECG manifestations in acute coronary syndromes.
• Accurate interpretation of atypical ECG patterns can improve patient outcomes in myocardial infarction.