Subtle de Winter in a 40 Years Old Male with No Chest Pain

Khalid Abdulrahman Ali Ateyyah

doi:doi:10.11648/j.ijbmr.20180602.12

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Subtle de Winter in a 40 Years Old Male with No Chest Pain

Khalid Abdulrahman Ali Ateyyah

Published in International Journal of Biomedical Materials Research (Volume 6, Issue 2)

Received: 21 June 2018 Accepted: 17 July 2018 Published: 15 August 2018

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Abstract

BACKGROUND: It is well known that the Electrocardiogram (ECG) is the first and most important test to diagnose patients with acute coronary syndrome (ACS). ST elevations on ECG in a patient presenting with chest pain is defined as ST elevation myocardial infarction (STEMI) and is confirmed by cardiac catheterization. Various STEMI equivalents have been reported in the literature. Most STEMI equivalents are often missed or not recognized by physicians. So, giving attention to these presentations are very important for physicians and cardiologist. The de Winter ECG pattern is one of the rare STEMI equivalents presentations which deserves emergent reperfusion therapy. CASE REPORT: This case report describes a very subtle ECG pattern which found to have critical occlusion of the proximal left anterior descending (LAD) artery in a previously healthy 40-year-old patient who presented to the Emergency Department (ED) with no chest pain. The patient did not have any risk factors for ACS and was not taking any medication. The initial ECG showed mild ST depression, which was changed to biphasic T wave later on. Recognizing this specific ECG pattern is important to direct patients toward appropriate management early and prevent delay in diagnoses.

Published in	International Journal of Biomedical Materials Research (Volume 6, Issue 2)
DOI	10.11648/j.ijbmr.20180602.12
Page(s)	35-39
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Acute Myocardial Infarction (AMI), Anterior Wall Acute Myocardial Infarction, Left Anterior Descending Artery (LAD) Occlusion, de Winter Sign, STEMI-Equivalent, Acute Coronary Syndrome (ACS), Primary Percutaneous Coronary Intervention (PCI), Revascularization

References

[1]	de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA; Interventional Cardiology Group of the Academic Medical Center (2008). A new ECG sign of proximal LAD occlusion. N Engl J Med. 359(19):2071-2073.
[2]	Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S; ESC Committee for Practice Guidelines (CPG) (2012). Third universal definition of myocardial infarction. Eur Heart J. 33(20):2551-2567.
[3]	Rokos IC, Farkouh ME, Reiffel J, Dressler O, Mehran R, Stone GW. Correlation between index electrocardiographic patterns and pre-intervention angiographic findings: insights from the HORIZONS-AMI trial (2012). Catheter Cardiovasc Interv. 1;79(7):1092-1098.
[4]	Martí D, Mestre JL, Salido L, Esteban MJ, Casas E, Pey J, Sanmartín M, Hernández-Antolín R, Zamorano JL. Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction (2014). Am Heart J. 168(6):884-890.
[5]	Martínez-Losas P, Fernández-Jiménez R. de Winter syndrome (2016). CMAJ. 19;188(7):528.
[6]	Gorgels AP. ST-elevation and non-ST-elevation acute coronary syndromes: should the guidelines be changed? (2013) J Electrocardiol. 46(4):318-323.
[7]	Rokos IC, French WJ, Mattu A, Nichol G, Farkouh ME, Reiffel J, et al. Appropriate cardiac cath lab activation: Optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J 2010;160:995-1003.
[8]	Verouden NJ, Koch KT, Peters RJ, Henriques JP, Baan J, van der Schaaf RJ, Vis MM, Tijssen JG, Piek JJ, Wellens HJ, Wilde AA, de Winter RJ. Persistent precordial "hyperacute" T-waves signify proximal left anterior descending artery occlusion (2009). Heart. 95(20):1701-1706.
[9]	de Winter RW, Adams R, Verouden NJ, de Winter RJ. Precordial junctional ST-segment depression with tall symmetric T-waves signifying proximal LAD occlusion (2016), case reports of STEMI equivalence. J Electrocardiol. 49(1):76-80.
[10]	Samadov F, Akaslan D, Cincin A, Tigen K, Sarı I. Acute proximal left anterior descending artery occlusion with de Winter sign (2014). Am J Emerg Med. 32(1):110.e1-110.e3.
[11]	Birnbaum Y, Nikus K, Kligfield P, Fiol M, Barrabés JA, Sionis A, Pahlm O, Niebla JG, de Luna AB. The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document (2014). Ann Noninvasive Electrocardiol. 19(5):412-425.
[12]	Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 39 (2,7):119-177. doi: 10.1093/eurheartj/ehx393.
[13]	Fiol Sala M, Bayés de Luna A, Carrillo López A, García-Niebla J. The "De Winter Pattern" Can Progress to ST-segment Elevation Acute Coronary Syndrome (2015). Rev Esp Cardiol (Engl Ed). 68(11):1042-3.
[14]	Zhao YT, Huang YS, Yi Z. de winters ECG changes and anterior myocardial infarction (2016). QJM. 109(4):269-71.
[15]	Goebel M, Bledsoe J, Orford JL, Mattu A, Brady WJ. A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T-wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr (2014). Am J Emerg Med. 32(3):287.e5-8.

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APA Style

Khalid Abdulrahman Ali Ateyyah. (2018). Subtle de Winter in a 40 Years Old Male with No Chest Pain. International Journal of Biomedical Materials Research, 6(2), 35-39. https://doi.org/10.11648/j.ijbmr.20180602.12

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ACS Style

Khalid Abdulrahman Ali Ateyyah. Subtle de Winter in a 40 Years Old Male with No Chest Pain. Int. J. Biomed. Mater. Res. 2018, 6(2), 35-39. doi: 10.11648/j.ijbmr.20180602.12

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AMA Style

Khalid Abdulrahman Ali Ateyyah. Subtle de Winter in a 40 Years Old Male with No Chest Pain. Int J Biomed Mater Res. 2018;6(2):35-39. doi: 10.11648/j.ijbmr.20180602.12

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@article{10.11648/j.ijbmr.20180602.12,
  author = {Khalid Abdulrahman Ali Ateyyah},
  title = {Subtle de Winter in a 40 Years Old Male with No Chest Pain},
  journal = {International Journal of Biomedical Materials Research},
  volume = {6},
  number = {2},
  pages = {35-39},
  doi = {10.11648/j.ijbmr.20180602.12},
  url = {https://doi.org/10.11648/j.ijbmr.20180602.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbmr.20180602.12},
  abstract = {BACKGROUND: It is well known that the Electrocardiogram (ECG) is the first and most important test to diagnose patients with acute coronary syndrome (ACS). ST elevations on ECG in a patient presenting with chest pain is defined as ST elevation myocardial infarction (STEMI) and is confirmed by cardiac catheterization. Various STEMI equivalents have been reported in the literature. Most STEMI equivalents are often missed or not recognized by physicians. So, giving attention to these presentations are very important for physicians and cardiologist. The de Winter ECG pattern is one of the rare STEMI equivalents presentations which deserves emergent reperfusion therapy. CASE REPORT: This case report describes a very subtle ECG pattern which found to have critical occlusion of the proximal left anterior descending (LAD) artery in a previously healthy 40-year-old patient who presented to the Emergency Department (ED) with no chest pain. The patient did not have any risk factors for ACS and was not taking any medication. The initial ECG showed mild ST depression, which was changed to biphasic T wave later on. Recognizing this specific ECG pattern is important to direct patients toward appropriate management early and prevent delay in diagnoses.},
 year = {2018}
}

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TY - JOUR
T1 - Subtle de Winter in a 40 Years Old Male with No Chest Pain
AU - Khalid Abdulrahman Ali Ateyyah
Y1 - 2018/08/15
PY - 2018
N1 - https://doi.org/10.11648/j.ijbmr.20180602.12
DO - 10.11648/j.ijbmr.20180602.12
T2 - International Journal of Biomedical Materials Research
JF - International Journal of Biomedical Materials Research
JO - International Journal of Biomedical Materials Research
SP - 35
EP - 39
PB - Science Publishing Group
SN - 2330-7579
UR - https://doi.org/10.11648/j.ijbmr.20180602.12
AB - BACKGROUND: It is well known that the Electrocardiogram (ECG) is the first and most important test to diagnose patients with acute coronary syndrome (ACS). ST elevations on ECG in a patient presenting with chest pain is defined as ST elevation myocardial infarction (STEMI) and is confirmed by cardiac catheterization. Various STEMI equivalents have been reported in the literature. Most STEMI equivalents are often missed or not recognized by physicians. So, giving attention to these presentations are very important for physicians and cardiologist. The de Winter ECG pattern is one of the rare STEMI equivalents presentations which deserves emergent reperfusion therapy. CASE REPORT: This case report describes a very subtle ECG pattern which found to have critical occlusion of the proximal left anterior descending (LAD) artery in a previously healthy 40-year-old patient who presented to the Emergency Department (ED) with no chest pain. The patient did not have any risk factors for ACS and was not taking any medication. The initial ECG showed mild ST depression, which was changed to biphasic T wave later on. Recognizing this specific ECG pattern is important to direct patients toward appropriate management early and prevent delay in diagnoses.
VL - 6
IS - 2
ER -

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Author Information

Khalid Abdulrahman Ali Ateyyah

College of Medicine, Taibah University, Madinah, Saudi Arabia

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Plain Text BibTeX RIS

APA Style

Khalid Abdulrahman Ali Ateyyah. (2018). Subtle de Winter in a 40 Years Old Male with No Chest Pain. International Journal of Biomedical Materials Research, 6(2), 35-39. https://doi.org/10.11648/j.ijbmr.20180602.12

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ACS Style

Khalid Abdulrahman Ali Ateyyah. Subtle de Winter in a 40 Years Old Male with No Chest Pain. Int. J. Biomed. Mater. Res. 2018, 6(2), 35-39. doi: 10.11648/j.ijbmr.20180602.12

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AMA Style

Khalid Abdulrahman Ali Ateyyah. Subtle de Winter in a 40 Years Old Male with No Chest Pain. Int J Biomed Mater Res. 2018;6(2):35-39. doi: 10.11648/j.ijbmr.20180602.12

Copy | Download

@article{10.11648/j.ijbmr.20180602.12,
  author = {Khalid Abdulrahman Ali Ateyyah},
  title = {Subtle de Winter in a 40 Years Old Male with No Chest Pain},
  journal = {International Journal of Biomedical Materials Research},
  volume = {6},
  number = {2},
  pages = {35-39},
  doi = {10.11648/j.ijbmr.20180602.12},
  url = {https://doi.org/10.11648/j.ijbmr.20180602.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbmr.20180602.12},
  abstract = {BACKGROUND: It is well known that the Electrocardiogram (ECG) is the first and most important test to diagnose patients with acute coronary syndrome (ACS). ST elevations on ECG in a patient presenting with chest pain is defined as ST elevation myocardial infarction (STEMI) and is confirmed by cardiac catheterization. Various STEMI equivalents have been reported in the literature. Most STEMI equivalents are often missed or not recognized by physicians. So, giving attention to these presentations are very important for physicians and cardiologist. The de Winter ECG pattern is one of the rare STEMI equivalents presentations which deserves emergent reperfusion therapy. CASE REPORT: This case report describes a very subtle ECG pattern which found to have critical occlusion of the proximal left anterior descending (LAD) artery in a previously healthy 40-year-old patient who presented to the Emergency Department (ED) with no chest pain. The patient did not have any risk factors for ACS and was not taking any medication. The initial ECG showed mild ST depression, which was changed to biphasic T wave later on. Recognizing this specific ECG pattern is important to direct patients toward appropriate management early and prevent delay in diagnoses.},
 year = {2018}
}

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