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Case Reports
. 2020 Jan;99(5):e18656.
doi: 10.1097/MD.0000000000018656.

The presence of De Winter electrocardiogram pattern following elective percutaneous coronary intervention in a patient without coronary artery occlusion: A case report

Shi Chen  1 , Hua Wang  1 , Liwei Huang  2
Affiliations
Case Reports

The presence of De Winter electrocardiogram pattern following elective percutaneous coronary intervention in a patient without coronary artery occlusion: A case report

Shi Chen et al. Medicine (Baltimore). 2020 Jan.

Abstract

Rationale: The De Winter electrocardiogram (ECG) pattern is considered as a ST elevated myocardial infarction (STEMI)-equivalent pattern. Due to its rare nature, it is unclear whether this ECG pattern suggests the presence of some other condition.

Patient concerns: We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI).

Diagnoses: An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction.

Intervention: The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin.

Outcomes: After a few hours, his symptoms were alleviated. The patient was discharged after 6 days of hospitalization without any complications.

Lessons: The De Winter ECG pattern can be observed in patients without significantly coronary arteries occlusion. The newly onset De Winter ECG pattern after PCI procedure may indicate perioperative myocardial infarction caused by impaired microvascular perfusion.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Initial ECG showing mild ST-segment elevation in the inferior leads (II, III, and aVF). ECG = electrocardiogram.
Figure 2
Figure 2
Emergency coronary angiography showing total occlusion in the distal segment of the right coronary artery (RCA), and severe stenosis in the middle segments of the left anterior descending (LAD) artery and left circumflex artery (LCX).
Figure 3
Figure 3
Coronary angiography after emergency PCI showing a very well developed right coronary artery with TIMI-3 blood flow. PCI = percutaneous coronary intervention.
Figure 4
Figure 4
Coronary angiography after second-stage PCI showing a very good blood flow in the left anterior descending (LAD) artery and left circumflex artery (LCX). PCI = percutaneous coronary intervention.
Figure 5
Figure 5
Post-procedural ECG showing junctional ST-depression and tall symmetrical T-waves in leads V2–4. ECG = electrocardiogram.
Figure 6
Figure 6
Emergency coronary angiography showing TIMI-3 flow in the left anterior descending (LAD) artery, left circumflex artery (LCX), and right coronary artery (RCA) without any in-stent thrombosis or main side branch occlusion.
Figure 7
Figure 7
ECG showing a deepened Q wave with resolution of ST-segment elevation in the precordial leads. ECG = electrocardiogram.
See this image and copyright information in PMC

References

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    1. De Winter RJ, Verouden NJW, Wellens HJJ, et al. A new ECG sign of proximal LAD occlusion. N Engl J Med 2008;359:2071–3. - PubMed
    1. de Winter RW, Adams R, Amoroso G, et al. Prevalence of junctional ST-depression with tall symmetrical T-waves in a pre-hospital field triage system for STEMI patients. J Electrocardiol 2019;52:1–5. - PubMed
    1. Verouden NJ, Koch KT, Peters RJ, et al. Persistent precordial “hyperacute” T-waves signify proximal left anterior descending artery occlusion. Heart 2009;95:1701–6. - PubMed
    1. Li RA, Leppo M, Miki T, et al. Molecular basis of electrocardiographic ST-segment elevation. Circ Res 2000;87:837–9. - PubMed

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