Precordial ST-segment continuum: A variant of the de Winter sign

The vast majority of patients with acute occlusion of the proximal left anterior descending coronary artery (LAD) suffer frank ST-elevation myocardial infarction (STEMI). In contrast, a small but not insignificant minority presents with an electrocardiographic (ECG) pattern termed the "de Winter sign." The de Winter sign is characterized by upsloping ST depression followed by tall and peaked T waves in the precordial leads. The purpose of this report is to present two cases of acute obstruction of a large wrap-around LAD where the ECGs simultaneously displayed diagnostic criteria both for STEMI and the de Winter sign. We provide possible explanations for this hitherto undescribed phenomenon.