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De Winter electrocardiogram pattern due to type A aortic dissection: a case report

Qing Zhang1, Dong-Dong Yang2, Yi-Fei Xu3

  • 1Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.

BMC Cardiovascular Disorders
|April 6, 2022
PubMed

Insights

The de Winter electrocardiograph (ECG) pattern, often indicating acute myocardial infarction (AMI), can also signal acute aortic dissection (AD). This case highlights the importance of considering AD in patients with this ECG finding, especially when it involves coronary arteries.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Thoracic Surgery

Background:

  • The de Winter electrocardiograph (ECG) pattern is an uncommon presentation of acute myocardial infarction (AMI).
  • Acute aortic dissection (AD) complicating AMI with a de Winter sign is rare and can lead to missed diagnoses.
  • This case involves AD affecting the left main (LM), left anterior descending (LAD), and left circumflex (LCX) coronary arteries.

Observation:

  • A 57-year-old male presented with acute chest pain and a de Winter ECG pattern.
  • Initial diagnosis of AMI was revised to acute AD, confirmed by transthoracic echocardiography (TTE).
  • The patient experienced cardiogenic shock, requiring intervention.

Findings:

  • Percutaneous coronary intervention (PCI) with stent implantation in the LM-LAD and LM-LCX successfully treated the acute coronary occlusion.
  • The patient's hemodynamics stabilized post-PCI, recovering from cardiogenic shock.
  • Two months later, the patient underwent successful ascending aorta replacement surgery.

Implications:

  • The de Winter ECG pattern warrants consideration of AD, particularly when LAD occlusion is suspected.
  • TTE is a valuable screening tool for diagnosing AD in this context.
  • Further research is needed to establish PCI as a viable treatment for AD-induced LAD occlusion when immediate aortic repair is not feasible.
Abstract

Keywords:
Acute myocardial infarctionAortic dissectionCase reportDe Winter electrocardiogram pattern

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