Interv Akut Kardiol. 2019;18(4):230-231

The under-recognized value of an electrocardiogram

Helder Santos, Inês Almeida, Hugo Miranda, Mariana Santos, Samuel Almeida, Lurdes Almeida,, Catarina Sousa, Joana Chin, Catarina Sá, Luís Santos, João Tavares

Cardiology Department, Centro Hospitalar Barreiro Montijo E. P. E., Barreiro, Portugal

In ST elevation myocardial infarction, an emergent coronary revascularization is recommended. Although, despite the recommendations not all the patients receive a standard therapy, due the presence of electrocardiogram (EKG) patterns that do not mimic a ST elevation. A 64-year-old male, smoker, was admitted for acute retroesternal pain, radiating to the jaw, associated with nausea and diaphoresis. EKG without a clear ST elevation but revealed a De Winter pattern. Transthoracic echocardiography showed hypokinesis in the mid and apical segments of the anterior wall, with preserved left ventricular ejection fraction. A coronary angiogram revealed a left anterior descending artery stenosis. After percutaneous coronary revascularization, there was clinical improvement, without other complications. De Winter pattern on the electrocardiogram is extremely predictive of acute left anterior descending coronary artery stenosis/occlusion. We highlight the importance of its interpretation as a STEMI equivalent and its indication to emergent reperfusion therapy.

Keywords: STEMI, left anterior descending coronary artery, de Winter pattern

Published: December 1, 2019  Show citation