This case highlights the importance of recognizing De Winter T waves as a STEMI-equivalent ECG pattern associated with acute LAD occlusion. Although this pattern does not present with classic ST elevation, early identification can enable rapid activation of reperfusion therapy.
A 72-year-old man with a history of hypertension and obesity (BMI 30.8) awoke at 01:00 AM with central chest pain radiating to the left arm. An ambulance ECG was recorded at 03:28 AM.
Prehospital ECG
Findings: Precordial De Winter T waves with poor R-wave progression. De Winter T waves are a hyperacute T-wave variant observed in approximately 2% of LAD occlusions and may occur without anterior ST-segment elevation.
Queen of Hearts recognized this ECG pattern and recommended immediate coronary angiography.
Clinical Outcome
- Angiogram (05:17 AM): Proximal LAD occlusion (TIMI 0 flow)
- Revascularization: TIMI 3 flow restored after PCI
- Echocardiography: Normal LVEF >55%, no regional wall motion abnormalities, normal LV systolic function
- Troponin: <2,000 ng/L
- Clinical course: No complications, discharged within 48 hours
