Navigating Electrocardiographic Risk Stratification and Therapeutic Strategies in Acute Coronary Syndrome Without...

Area of Science:

• Cardiology
• Electrocardiography
• Medical Diagnostics

Background:

• Acute proximal left anterior descending (LAD) artery occlusion can present with atypical electrocardiographic (ECG) findings.
• The de Winter pattern, characterized by junctional upsloping ST-segment depression and tall, symmetrical T waves, is a recognized but less common manifestation.
• This pattern signifies a high risk of transmural infarction if not treated promptly.

Purpose of the Study:

• To highlight the significance of the de Winter ECG pattern as a STEMI equivalent.
• To present a case of proximal LAD in-stent occlusion manifesting the de Winter pattern.
• To discuss the diagnostic and therapeutic implications of this ECG finding.

Main Methods:

• Case report of a patient with acute proximal LAD occlusion and de Winter ECG pattern.
• Review of the literature concerning the de Winter ECG pattern and ST-segment depression morphology.
• Discussion of the pathophysiology and management strategies for this condition.

Main Results:

• The presented patient with LAD in-stent occlusion showed the de Winter ECG pattern.
• Successful emergency percutaneous coronary intervention (PCI) was performed.
• The patient achieved a good outcome following prompt recognition and management.

Conclusions:

• The de Winter ECG pattern should be recognized as a STEMI equivalent requiring urgent management.
• Prompt PCI is essential for patients with the de Winter pattern to prevent significant myocardial infarction.
• Understanding ECG morphology in acute coronary syndromes aids in risk stratification and therapeutic decision-making.