Introduction. Rapid diagnosis of acute myocardial infarction is essential for
proper treatment and reduction of patient mortality. Electrocardiography
plays an important role in its diagnosis. Acute myocardial infarction with
ST segment elevation requires urgent reperfusion therapy, that is, primary
percutaneous coronary revascularization. A small number of patients with
acute myocardial infarction have ST segment depression in one or more
leads, whereas ST segment elevation in augmented vector right the
electrocardiogram is characteristic for a myocardial infarction without ST
elevation, but the clinical course and the severity of disease correspond to
the anterior myocardial infarction with ST segment elevation. De Winter
T-wave electrocardiography. One of these forms is known as de Winter T-wave
pattern, characterized by ST segment depression at the J-point (> 1 mm) in
the precordial leads, the absence of ST segment elevation in the precordial
leads, high peaked and symmetrical T-waves in the precordial leads and, in
most cases, mild ST segment elevation (0.5 mm to 1 mm) in the augmented
vector right. These patients have occlusion of the left main coronary
artery, occlusion of the proximal segment of the anterior descending artery,
or a severe multivessel coronary disease. Patients with this
electrocardiographic pattern, which is equivalent to acute myocardial
infarction with ST segment elevation, require consideration of emergency
reperfusion therapy due to high mortality, compared to other patients with
acute myocardial infarction without ST elevation. Primary percutaneous
intervention is recommended, or if there is no catheterization laboratory
nearby, fibrinolytic therapy may be considered. Because of the lack of clear
recommendations, treatment decisions are made individually, from case to
case. Conclusion. We need large pro?spective studies with this specific
electrocardiographic pattern to provide quick recognition and proper
treatment of the anterior myocardial infarction with ST elevation.
Clinical prognosis, pre-existing conditions and the use of reperfusion therapy for patients with ST segment elevation acute myocardial infarction
