Atypical de Winter ECG: What is the Culprit?
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Abstract
Various ECG patterns can help determine the location of the occluded coronary artery and the extent of threatened myocardium. The reported positive predictive value for de Winter ECG in predicting acute left anterior descending artery occlusion is inconsistent. Additionally, the morphology of ST depression and other ECG findings may have varying degrees of severity and prognostic significance. This case demonstrates the importance of integrating multiple ECG findings, such as ST elevation, Q waves, and the R/S ratio, with the location of the de Winter pattern on various ECG leads to accurately predict the culprit artery and assess the anatomical extent of myocardial ischemia.
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7. Yang Y, Ma Y, Yin D, Zhang Y, Song W, Cheng Y, Fu T, Zhang R, Liu Y, Kang K, Wang L, Jiang Y, Lu Y. Atypical and delayed de Winter electrocardiograph pattern: A case report. Medicine (Baltimore) 2019;98:e15436.
8. Kabra R, Acharya S, Kamat S, Kumar S. ST-Segment Elevation in Lead aVR With Global ST-Segment Depression: Never Neglect Left Main Coronary Artery (LMCA) Occlusion. Cureus 2022;14:e26522.
9. Kossaify A. ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome. Clin Med Insights Case Rep 2013;6:41-45.
10. Alsagaff MY, Amalia R, Dharmadjati BB, Appelman Y. Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series. J Med Case Rep 202216:321.
11. Ranjbar A, Sohrabi B, Sadat-Ebrahimi SR, Ghaffari S, Kazemi B, Aslanabadi N, Seyvani B, Hajizadeh R. The association between T wave inversion in leads with ST-elevation and patency of the infarct-related artery. BMC Cardiovasc Disord 2021;21:27.
12. Tsutsumi K, Tsukahara K. Is The Diagnosis ST-Segment Elevation or Non-ST-Segment Elevation Myocardial Infarction? Circulation 2018;138:2715-2717.
2. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA; Interventional Cardiology Group of the Academic Medical Center. A new ECG sign of proximal LAD occlusion. N Engl J Med 2008;359:2071-2073.
3. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019;40:237-269.
4. Lin TC, Lee WS, Kong CW, Chan WL. Congenital absence of the left circumflex coronary artery. Jpn Heart J 2003;44:1015-1020.
5. Wang J, Li J, Diao S, Xu H, Ding F. Atypical de Winter ECG pattern may be the mirror image of ST elevation. Ann Noninvasive Electrocardiol 2022;27:e12915.
6. Kainat A, Ain NU, Boricha H, Gulzar M, Dueweke EJ. Atypical de Winter Presentation of Critical Left Anterior Descending Coronary Artery Occlusion. Cureus 2022;14:e24724.
7. Yang Y, Ma Y, Yin D, Zhang Y, Song W, Cheng Y, Fu T, Zhang R, Liu Y, Kang K, Wang L, Jiang Y, Lu Y. Atypical and delayed de Winter electrocardiograph pattern: A case report. Medicine (Baltimore) 2019;98:e15436.
8. Kabra R, Acharya S, Kamat S, Kumar S. ST-Segment Elevation in Lead aVR With Global ST-Segment Depression: Never Neglect Left Main Coronary Artery (LMCA) Occlusion. Cureus 2022;14:e26522.
9. Kossaify A. ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome. Clin Med Insights Case Rep 2013;6:41-45.
10. Alsagaff MY, Amalia R, Dharmadjati BB, Appelman Y. Isolated posterior ST-elevation myocardial infarction: the necessity of routine 15-lead electrocardiography: a case series. J Med Case Rep 202216:321.
11. Ranjbar A, Sohrabi B, Sadat-Ebrahimi SR, Ghaffari S, Kazemi B, Aslanabadi N, Seyvani B, Hajizadeh R. The association between T wave inversion in leads with ST-elevation and patency of the infarct-related artery. BMC Cardiovasc Disord 2021;21:27.
12. Tsutsumi K, Tsukahara K. Is The Diagnosis ST-Segment Elevation or Non-ST-Segment Elevation Myocardial Infarction? Circulation 2018;138:2715-2717.
| Files | ||
| Issue | Vol 19 No 2 (2024): J Teh Univ Heart Ctr | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/jthc.v19i2.16204 | |
| Keywords | ||
| Culprit artery Posterolateral ST-segment elevation myocardial infarction | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Rachmi DA, Mulia EPB, Fagi RA. Atypical de Winter ECG: What is the Culprit?. J Tehran Heart Cent. 2024;19(2):136-140.
