‘De Winter’ electrocardiographic pattern in left bundle branch block and acute coronary occlusion: a case report

ST-segment elevation on electrocardiogram (ECG) is traditionally interpreted as acute coronary occlusion, with a sensitivity of approximately 75%. Electrocardiographic patterns such as ‘Wellens’ and ‘De Winter’ have been studied as ST-segment elevation myocardial infarction (STEMI) equivalents.

A 79-year-old hypertensive woman was admitted with chest pain radiating to the neck. The initial ECG showed a left bundle branch block with a ‘De Winter’ pattern. After initial care, she underwent cardiac catheterization that revealed thrombotic occlusion of the left anterior descending artery. She underwent angioplasty with angiographic success and clinical improvement, leading to hospital discharge.

Recognition of electrocardiographic patterns associated with acute coronary occlusion is crucial for diagnosis and prompt reperfusion, reducing morbidity and mortality. The ‘De Winter’ pattern is an equivalent to STEMI. Patients with pre-existing conditions that affect QRS amplitude and width, such as the left bundle branch block, pose an additional challenge.