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De Winter pattern: a forgotten pattern of acute LAD artery occlusion
  1. Mafalda Carrington,
  2. Ana Rita Santos,
  3. Bruno Cordeiro Picarra,
  4. João António Pais
  1. Department of Cardiology, Hospital do Espirito Santo EPE, Evora, Portugal
  1. Correspondence to Dr Mafalda Carrington, mafaldacarrington{at}

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The De Winter ECG pattern was reported as an indicator of acute left anterior descending (LAD) coronary artery occlusion and is considered an anterior ST-elevation myocardial infarction (STEMI) equivalent.1 The key diagnostic features include ST-depression and peaked T-waves in precordial leads, and it can be seen in around 2% of patients with anterior myocardial infarction.1 2

We report a case of a 77-year-old woman with history of treated hypertension and hypercholesterolaemia. She presented to the emergency department with a typical acute chest pain, almost 1 hour after symptom onset. An ECG was immediately obtained and revealed sinus bradycardia at 45 bpm, with 1–2 mm ST-depression at the J point that continued into a wide, tall, positive, symmetrical T-wave in leads V2–V6, and a 0.5 mm ST-elevation in lead aVR (figure 1A). She was immediately transferred to our primary coronary intervention (PCI) …

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