Key result
Urgent percutaneous coronary intervention successfully re-established arterial blood flow and normalized the ECG in a patient presenting with the rare de Winter's pattern.
Why the study?
Although not classified as a STEMI, patterns known as STEMI equivalents require prompt recognition and treatment.
Case Report (n=1)
No
The de Winter's pattern on ECG is a STEMI equivalent indicating significant LAD occlusion that requires urgent percutaneous intervention.
Answers are grounded in this paper and cite their sources.
May prompt urgent angiography in suspected de Winter's pattern; leaves open prospective validation of outcomes.
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.
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Prasad et al. (2021) conducted a case report in de Winter's pattern / proximal LAD occlusion (n=1). Percutaneous coronary intervention (PCI) was evaluated on Arterial blood flow re-establishment and ECG normalization. Urgent percutaneous coronary intervention successfully re-established arterial blood flow and normalized the ECG in a patient presenting with the rare de Winter's pattern.
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