'De Winter' electrocardiographic pattern in left bundle branch block and acute coronary occlusion: a case report

Area of Science:

• Cardiology
• Electrocardiography

Background:

• ST-segment elevation on electrocardiogram (ECG) typically signifies acute coronary occlusion.
• Electrocardiographic patterns like Wellens' and De Winter are recognized as ST-segment elevation myocardial infarction (STEMI) equivalents.
• Diagnosing STEMI requires prompt recognition of specific ECG findings for timely reperfusion therapy.

Observation:

• A 79-year-old woman presented with chest pain and a left bundle branch block (LBB) with a De Winter ECG pattern.
• Cardiac catheterization revealed thrombotic occlusion of the left anterior descending artery.
• The patient underwent successful angioplasty and was discharged in stable condition.

Findings:

• The De Winter pattern, an ECG equivalent to STEMI, was observed in a patient with LBB.
• This case highlights the challenge of interpreting ECG findings in patients with pre-existing conditions affecting QRS morphology.
• Successful reperfusion therapy was achieved despite the complex ECG presentation.

Implications:

• Recognizing the De Winter pattern is crucial for identifying acute coronary occlusion, especially in patients with LBB.
• Prompt diagnosis and intervention for STEMI equivalents can significantly reduce patient morbidity and mortality.
• This case underscores the importance of considering STEMI equivalents in the differential diagnosis of acute chest pain.