de Winters pattern: Spotted and successfully thrombolysed with streptokinase

Abstract

When it comes to management of acute coronary syndrome (ACS), no other investigation can replace the role electrocardiogram (ECG) that still holds the pivotal role in emergency rooms. Rightfully thence, the classification of ACS patients into ST elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) is based on these zig-zag lines on a squared paper strip. This classification is important as both the groups differ in their pathophysiology as well as management. While, thrombolysis or percutaneous coronary intervention is done in STEMI sufferers; thrombolysis is contraindicated in the ones with NTEMI. There are, however, some patterns which do not show obvious ST elevation in ECG but are in fact associated with critical narrowing of major heart vessels. de Winter is one such “NSTEMI-STEMI equivalent.” Although now widely agreed on as a STEMI equivalent, its management with streptokinase (STK) is controversial. We are reporting a case of 38-year-old male with chest pain, whose ECG revealed the classical de Winter pattern and was successfully thrombolysed with STK. Complete set of classical ECG tracings and its management with STK (perhaps first such report across the globe) are the two major highlights of this report.

Keywords

• de Winter sign
• ST elevation myocardial infarction equivalent
• streptokinase
• thrombolysis