Key result
Precordial swirl sign on ECG unmasks severe proximal LAD in-stent restenosis treated with drug-coated balloon.
Why the study?
The precordial swirl sign may provide an electrocardiographic clue to anterior myocardial ischemia in patients who do not meet conventional ST-segment elevation myocardial infarction criteria.
Case Report (n=1)
No
Recognition of the precordial swirl sign on ECG (focal ST-segment elevation in V1, hyperacute T wave in V2, and reciprocal ST-segment depression in V5-V6) can unmask severe anterior myocardial ischemia in patients who do not initially meet conventional STEMI criteria or have negative initial troponin results.
Hypothesis-generating for precordial swirl sign in non-STEMI ECGs; requires prospective validation before influencing reperfusion decisions.
Precordial swirl sign may provide a clue to anterior myocardial ischemia in patients whose electrocardiograms do not meet conventional ST-segment elevation myocardial infarction criteria. A 75-year-old man with previous coronary stenting presented with worsening chest pain and an initially negative troponin result. His admission electrocardiogram showed focal ST-segment elevation in V1, a hyperacute T wave in V2, and reciprocal ST-segment depression in V5-V6. Subsequent anterior Twave inversion and troponin elevation supported an ischemic interpretation. Coronary angiography revealed approximately 90% proximal left anterior descending coronary artery in-stent restenosis with TIMI 2 flow. Balloon angioplasty followed by drug-coated balloon treatment restored TIMI 3 flow. This case illustrates the importance of interpreting opposing precordial ST-T changes in relation to the ischemic vector rather than considering ST-segment elevation thresholds alone. Recognition of this pattern may prompt serial electrocardiography, repeat biomarker testing, and timely assessment for coronary intervention.
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Lee et al. (2026) conducted a case report in Anterior myocardial ischemia due to proximal LAD in-stent restenosis (n=1). Precordial swirl sign on ECG followed by balloon angioplasty and drug-coated balloon treatment was evaluated on Identification of proximal LAD in-stent restenosis and restoration of coronary flow. Precordial swirl sign on ECG unmasked ~90% proximal LAD in-stent restenosis in a 75-year-old man, with drug-coated balloon angioplasty restoring TIMI 3 flow.
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