Acute Coronary Syndrome Manifesting Dynamic Electrocardiographic Changes

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Electrocardiography

Background:

• Acute coronary syndrome (ACS) encompasses a spectrum of clinical presentations.
• Electrocardiogram (ECG) findings are crucial for diagnosing myocardial infarction and guiding treatment.
• Dynamic ECG changes can indicate evolving myocardial ischemia and guide therapeutic interventions.

Purpose of the Study:

• To present a unique case of dynamic ECG evolution in ACS.
• To highlight the diagnostic significance of the de Winter ECG pattern.
• To emphasize the importance of timely intervention in cases of severe residual ischemia.

Main Methods:

• Case report of a patient presenting with ACS.
• Serial electrocardiogram (ECG) monitoring to observe dynamic changes.
• Coronary angiography to identify culprit artery stenosis.
• Percutaneous coronary intervention (PCI) as the therapeutic intervention.

Main Results:

• The patient initially presented with an anterior ST-segment elevation myocardial infarction (STEMI) ECG pattern.
• The ECG dynamically evolved to the de Winter pattern, indicative of severe myocardial ischemia.
• Coronary angiography revealed a subtotally occluded culprit artery with partial recanalization.
• Successful emergency PCI was performed, restoring coronary blood flow.

Conclusions:

• Dynamic ECG changes, including the de Winter pattern, can signify critical residual stenosis after initial reperfusion or in evolving ACS.
• The de Winter ECG pattern warrants prompt investigation and intervention to prevent adverse outcomes.
• Timely PCI is effective in managing acute coronary events with dynamic ECG manifestations.