scholarly journals de Winter syndrome or inferior STEMI?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shijun Wang ◽  
Liang Shen
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Right Coronary Artery ◽  
Reperfusion Therapy ◽  
Total Occlusion ◽  
Case Presentation ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
The Right

Abstract Background The de Winter electrocardiography (ECG) pattern is associated with acute total or subtotal occlusion of the left anterior descending coronary artery (LAD) characterized by upsloping ST-segment depression at the J point in leads V1–V6 without ST-segment elevation. Case presentation We report an atypical style case of the de Winter ECG pattern accompanied by ST elevation in inferior leads. The patient underwent emergency coronary angiography, which revealed total occlusion of the proximal LAD with no observable stenosis in the right coronary artery. Conclusion ECG-related changes in acute total LAD occlusion can present with the de Winter pattern and ST elevation in inferior leads. Recognizing this atypical ECG pattern is critical for immediate reperfusion therapy.

scholarly journals Total Occlusion of the Left Descending and circumflex Coronary Artery without ST Elevation: the De Winter electrocardiographic pattern

2020 ◽  
Vol 19 (3) ◽  
pp. 159-161
Author(s):  
Asim Kalkan ◽  
◽  
Bora Cekmen ◽  
Behlul Bas ◽  
Mehmet Taylan Kocer ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Infarctions ◽  
Circumflex Coronary Artery ◽  
Total Occlusion ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
Sharp Waves ◽  
St Depression ◽  
St Segment ◽  
St Elevation

de Winter syndrome, or anterior ST segment elevation myocardial infarction (STEMI), constitutes 2% of acute myocardial infarctions. In contrast to classic ST segment elevation as seen with STEMI, it involves ST depression with precordial derivations and sharp waves. de Winter syndrome indicates critical narrowing of the left ascending coronary artery (LAD). Recognizing this presentation is important in terms of both mortality and morbidity. We present the case of a 71-year old patient presenting at the Emergency Department with chest pain, who had findings of de Winter syndrome on their ECG. Coronary angiography confirmed occlusions in the LAD and circumflex (CX) coronary arteries.

scholarly journals Correlation of ECG Changes with Coronary Angiographic Findings in Acute Inferior Myocardial Infarction

2017 ◽  
Vol 29 (2) ◽  
pp. 33-37 ◽  
Author(s):  
Kazi Shamim Al Mamun ◽  
Anisul Awal ◽  
AKM Manzur Murshed
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Inferior Myocardial Infarction ◽  
Significant Stenosis ◽  
St Segment Elevation ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation ◽  
Acute Inferior Myocardial Infarction

The determination of infarct related artery in acute inferior myocardial infarction is extremely important for the prediction the amount of myocardium at risk and guide decisions regarding urgency of revascularization. Urgent decision may facilitate management and prevention of complication. Our objective was to Identification of the infarct related artery involving either right coronary artery (RCA) or left circumflex artery (LCX) in acute inferior wall myocardial infarction using electrocardiographic criteria and comparing with angiographic finding. This prospective, observational study was done in Chittagong Medical College Hospital from June 2013 to May 2014. A total of 112 Patients with acute inferior myocardial infarction were included in this study. The electrocardiogram of these patients evaluated for ST segment elevation in lead III exceeding that in lead II (i.e. a ratio of ST elevation in lead III/elevation in lead II > 1) and S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL as a prediction for right coronary artery occlusion. If criteria are negative, LCX obstruction is likely. Coronary angiogram was done within 2-6 weeks in cath lab, department of cardiology, CMCH to identify the culprit artery. The infarct related artery (IRA) was identified from total occlusion or significant stenosis (> 70%) of the RCA or LCX or their major branches, or from arteriographic evidence of intraluminal thrombosis. To minimize the chance of misclassifying the culprit artery, patients with significant stenosis of both the RCA and the LCX were excluded from the study. The study population consisted of 112 patients (94 male and 18 female) with a mean ± SD age of 51 ± 8.6 years. On coronary angiography, the culprit artery was shown to be the RCA in 92 patients and the LCX in 20 patients. It was evident that the degree of ST segment elevation in lead III was significantly higher in right coronary artery group (92 patients) vs left circumflex group (20 patients) 3.16±1.14mm vs 1.35±0.24mm (p<0.001) respectively. While its comparable in lead II 2.18±0.95mm vs 1.7±0.34mm (p>0.05). In respect to leads AVL, we found that deeper ST segment depression was in right coronary artery group as compared to left circumflex group 1.11±0.25mm vs 0.2 ±0.34mm (p<0.001). ECG parameters for implicating the RCA were a higher ST elevation in lead III than lead II (specificity 98%, sensitivity 97%) and an S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL (specificity 96%, sensitivity 95%). Absence of these criteria was associated with LCX occlusion (specificity 100%, sensitivity 85%). It is possible to predict the culprit artery whether right coronary artery or left circumflex by examining the surface electrocardiography in patients with acute inferior myocardial infarction.Medicine Today 2017 Vol.29(2): 33-37

scholarly journals Anomalous origin of left main coronary artery from right coronary artery in a patient presenting with inferior wall myocardial infarction: a case report and literature review

2019 ◽  
Vol 3 (4) ◽  
pp. 1-6
Author(s):  
Dipesh Ludhwani ◽  
Vincent Woo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Left Main Coronary Artery ◽  
Anomalous Origin ◽  
Single Coronary Artery ◽  
Inferior Wall ◽  
Left Main ◽  
St Segment Elevation ◽  
St Segment ◽  
The Right

Abstract Background Anomalous origin of the coronary arteries is seen in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. We present an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and following a prepulmonic course. Case summary A 72-year-old woman presented due to ongoing chest pain with associated ST-segment elevation involving the inferior leads. Emergent cardiac catheterization revealed a 99% ulcerated lesion in distal RCA, which was intervened on with angioplasty and stent placement. The RCA was noted giving rise to LMCA, which followed a prepulmonic course (anterior to pulmonary artery) before trifurcating into a small caliber left anterior descending, ramus intermedius, and hypoplastic left circumflex arteries. The non-malignant course of the aberrant LMCA was confirmed on the coronary computed tomography angiogram. The patient was discharged home on guideline-directed medical therapy. Discussion The patient illustrated congenital SCA with type RIIA pattern of the aberrant vessel based on the Lipton anatomic classification for SCA. The prepulmonic course of SCA is usually benign and can be managed conservatively.

scholarly journals Atypical location of ST elevation acute myocardial infarction in relation to the electrocardiogram

2019 ◽  
Vol 72 (5-6) ◽  
pp. 176-179
Author(s):  
Vladimir Ivanovic ◽  
Dragana Dabovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Milovan Petrovic ◽  
Slobodan Dodic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Collateral Circulation ◽  
St Segment ◽  
St Elevation ◽  
The Right ◽  
Elevation Acute Myocardial Infarction ◽  
Proximal Right Coronary Artery

Introduction. Electrocardiography is an initial non-invasive diagnostic algorithm for ST elevation acute myocardial infarction. Specific electrocardiographic phenomenon is described, when the occlusion of the proximal segment of the right coronary artery or the isolated occlusion of its ventricular branch is presented with ST elevation in the precordial leads. Case Report. A 78-year-old woman was admitted as an emergency due to chest pain and electrocardiographically recorded concave elevation in leads V1 - V3. She was diagnosed with ST elevation myocardial infarction of the anterior region and sent to catheterization laboratory for emergency coronary angiography. It showed an occlusion of the proximal-medial right coronary artery. Behind the occlusion, the right coronary artery, posterior descending artery and posterior lateral artery, a hetero-collateral circulation was seen. Two drug-eluting stents were implanted into the proximal segment of the right coronary artery. Discussion. The phenomenon of acute myocardial infarction caused by occlusion of the proximal right coronary artery and/or ventricular branches of the right coronary artery, presenting with ST segment elevation in the precordial leads, is a consequence of several anatomical variations: occlusion of nondominant right coronary artery, isolated occlusion of the ventricular branch of the right coronary artery, and the occlusion of the right coronary artery proximal to the ventricular branch with hetero collateral circulation on the periphery of the right coronary artery, like in our case. Electrocardiographic characteristic pointing to the occlusion of the proximal right coronary artery and/or ventricular branches of the right coronary artery is higher ST elevation in the lead V1 than in the other leads, followed by the absence of Q wave development. This ST elevation is concave. Conclusion. It is necessary to emphasize the significance of differential diagnosis of culprit lesion in patients with chest pain and elevation of the ST segment in the precordial leads having in mind further different thera peutic algorithms. Patients with right ventricular myo cardial infarction need to maintain an adequate ?preload? and avoid vasodilators in order to maintain the right ventricular stroke volume.

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