Transmural myocardial infarction with de Winter's sign on ECG. / Transmuralt hjerteinfarkt med de Winters tegn i EKG.

ABSTRACT

BACKGROUND: De Winter's sign represents a constellation of ECG changes including upward sloping ST depressions greater than 1 mm at the J-point, which end in tall, symmetrical T waves in the precordial leads and reciprocal ST elevation in aVR. The pattern is considered specific for acute occlusion of the LAD. CASE PRESENTATION A previously healthy man in his forties was referred from urgent care with suspected non-ST-elevation myocardial infarction (NSTEMI) which presented with acute chest pain, ECG with ST depressions and positive troponin-T. Repeat ECG at the local hospital showed further changes, leading to echocardiogram which revealed pronounced cardiac hypokinesia both in the septum and apex. The patient was transferred to the closest interventional cardiology centre and underwent successful PCI. ECG findings were later interpreted as consistent with de Winter's sign. INTERPRETATION: This case illustrates the importance of recognising other ECG changes in addition to ST elevation as indicative of acute reperfusion therapy.