Should de Winter T-Wave Electrocardiography Pattern Be Treated as ST-Segment Elevation Myocardial Infarction Equivalent with Consequent Reperfusion? A Dilemmatic Experience in Rural Area of Indonesia

Case Reports in Cardiology
Raymond PranataVito Damay

Abstract

Although de Winter T-wave electrocardiography pattern is rare, it signifies proximal left anterior descending artery occlusion and is often unrecognized by physicians. The aim of this case report was to highlight the dilemma in the management of a patient with de Winter T-wave pattern in the hospital without interventional cardiology facility. A 65-year-old male presented with typical chest pain since 2 hours before admission, and ECG showed sinus rhythm of 57 bpm and >1 mm upsloping ST depression with symmetric tall T in lead V2-3 characteristic of de Winter T-wave ECG pattern. He was given dual antiplatelet therapy, nitrate, statin, and anticoagulant. He refused referral to interventional cardiology available hospital. 3 hours after admission, the electrocardiography transformed into Q-waves consistent with final stages of acute STEMI and ST-segment elevation that barely meets the threshold in the guideline, and thrombolytic was administered and successful. There is a suggestion that de Winter T-wave electrocardiography should be treated as ST-segment myocardial infarction equivalent and should undergo coronary angiography; however, not every hospital has the luxury of interventional cardiology facility. The other modality fo...Continue Reading

References

Nov 7, 2008·The New England Journal of Medicine·Robbert J de WinterUNKNOWN Interventional Cardiology Group of the Academic Medical Center
Jun 28, 2011·JACC. Cardiovascular Interventions·Ali E DenktasRichard W Smalling
Dec 19, 2012·Circulation·Patrick T O'GaraUNKNOWN American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Sep 28, 2015·Revista Española De Cardiología·Miquel Fiol SalaJavier García-Niebla
Dec 30, 2015·The American Journal of Emergency Medicine·Yun-Tao ZhaoZhong Yi
Apr 1, 2017·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Niall P Morris, Richard Body

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Citations

Nov 25, 2019·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Lingzhi ZhangXiaoyan Jiang
Jun 27, 2020·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Zhong-Qun ZhanAdrian Baranchuk
Feb 23, 2020·Heart Views : the Official Journal of the Gulf Heart Association·Yaser AlahmadHisham Swehli
Jun 21, 2020·The American Journal of Emergency Medicine·Raymond PranataVeselin Mitrovic
Jun 3, 2021·Computer Methods and Programs in Biomedicine·Aizatul Shafiqah Mohd FaizalSiow-Wee Chang

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