Evolutionary de Winter pattern: from de Winter ECG to STEMI-A case report

BACKGROUND: De Winter pattern is associated with acute occlusion in the left anterior descending coronary artery combined with upsloping ST-segment depression at the J point in leads V(1) through V(6) without ST-segment elevation. The ECG changes in this case were illustrated by an up-sloping ST-segment depression in the V(1) to V(6) leads, followed by tall and symmetrical T waves. Changes from de Winter to ST-segment elevation myocardial infarction (STEMI) are rare. CASE PRESENTATION: Our case illustrated an evolutionary de Winter sign that changed to STEMI; the patient underwent cardiac catheterization in time. CONCLUSIONS: Patients who have an electrocardiogram showing de Winter changes may require primary percutaneous coronary intervention. Emergency physicians and cardiologists should not ignore these changes.