The rare presentation of the de Winter's pattern: Case report and literature review

Although not classified as a ST elevated myocardial infarction (STEMI), the patterns known as equivalents also require prompt recognition and treatment. A 50-year-old male with no pertinent history presented to the emergency department for chest pain that radiated to his left shoulder. An electrocar...

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Bibliographic Details
Published in:American heart journal plus 2021-03, Vol.3, p.100013-100013, Article 100013
Main Authors: Prasad, Rohan Madhu, Al-abcha, Abdullah, Elshafie, Ahmed, Radwan, Yasser Amr, Baloch, Zulfiqar Qutrio, Abela, George S.
Format: Article
Language:English
Subjects:
Case report
de Winter's pattern
Percutaneous intervention
STEMI equivalents
Thrombolysis
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Summary:Although not classified as a ST elevated myocardial infarction (STEMI), the patterns known as equivalents also require prompt recognition and treatment. A 50-year-old male with no pertinent history presented to the emergency department for chest pain that radiated to his left shoulder. An electrocardiogram (EKG) revealed findings consistent with the de Winter's pattern, which were greater than 1 mm upsloping ST depressions at the J point in leads V3-V6 (maximally in leads V3–V5), tall, peaked T waves in leads II, III, and V3–V5, ST elevations in lead aVR, and 1 mm ST elevation in V1 and V2. The physical exam, troponins, and other laboratory investigations were unrevealing. Urgent, diagnostic coronary angiography revealed complete occlusion of the proximal left anterior descending (LAD) artery, which was successfully treated with percutaneous coronary intervention (PCI) and two drug-eluting stents. After the stent placement, arterial blood flow was re-established and the ECG normalized. The patient was started on guideline based treatment and discharged home once medically stable. The de Winter's pattern on electrocardiogram indicates a significant coronary artery disease. This pattern requires urgent intervention, typically percutaneous stent placement.
ISSN:2666-6022
2666-6022
DOI:10.1016/j.ahjo.2021.100013