[De Winter sign with complete atrioventricular block and right coronary occlusion in non-ST-elevation myocardial
János Tomcsányi1, Balázs Sas1, Gábor Kelemen-Hunor1
11 Betegápoló Irgalmasrend Budai Irgalmasrendi Kórháza, Kardiológia Budapest, Árpád fejedelem u. 7. II. em., 1023 Magyarország.
Insights
A rare De Winter sign on an ECG indicated a right coronary artery occlusion, not the typical left anterior descending artery blockage, in a patient with atypical chest pain. This case highlights the De Winter sign
Area of Science:
- Cardiology
- Electrocardiography
- Emergency Medicine
Background:
- The De Winter sign is a specific electrocardiogram (ECG) finding often associated with acute left anterior descending artery (LAD) occlusion in non-ST-elevation myocardial infarction (NSTEMI).
- Atypical chest pain presentations can complicate the diagnosis of acute coronary syndromes.
Purpose of the Study:
- To report a case of De Winter sign associated with right coronary artery (RCA) occlusion.
- To emphasize the importance of recognizing variations in ECG patterns for diagnosing acute coronary artery occlusions.
Main Methods:
- Case report of an 89-year-old female patient presenting with atypical chest pain.
- Electrocardiogram (ECG) analysis revealing complete atrioventricular block, junctional rhythm, and De Winter sign.
- Immediate coronary angiography to investigate the cause of the ECG findings.
Main Results:
- ECG showed the De Winter sign, typically indicative of LAD occlusion.
- Coronary angiography revealed acute occlusion of the right coronary artery (RCA).
- This presentation is unusual, as only two prior cases of De Winter sign not caused by LAD occlusion have been reported.
Conclusions:
- The De Winter sign can indicate acute coronary artery occlusion beyond the LAD, including the RCA.
- Widespread awareness and recognition of this characteristic ECG pattern are crucial for timely diagnosis and management of acute coronary occlusions, especially in patients without ST-elevation.
- This case underscores the need for a comprehensive diagnostic approach when interpreting ECG findings in the context of acute coronary syndromes.
Abstract:
The authors present a case where, in an 89-year-old female patient with atypical chest pain, complete atrioventricular block and junctional rhythm with De Winter sign were detected on the ECG. As De Winter pattern is a left anterior descending artery (LAD) occlusion sign in non-ST-elevation myocardial infarction, immediate coronary angiography was performed, which showed occlusion of the right coronary artery though. To our knowledge, two cases have been reported so far where De Winter’s signal was not caused by LAD occlusion. The authors consider it important to widely propagate this recently described, characteristic ECG signal, which helps in the recognition of acute coronary artery occlusions in patients who do not have ST elevation on the ECG. Orv Hetil. 2024; 165(45): 1794–1797.
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