De Winter Wave with ST Segment Elevation Equivalent with Speech Disorder; A Case Report

Year 2022, Volume: 13 Issue: 1, 19 - 21, 08.03.2022

Ahmet Burak Erdem Miray Tümer

https://doi.org/10.33706/jemcr.991552

Abstract

ABSTRACT
Acute coronary syndrome is a clinical condition that may require urgent coronary intervention. The most important is myocardial infarction with ST elevation. Emerging clinical studies now show equivalents of ST elevation myocardial infarction without ST elevation. The de Winter wave has been recognized as the equivalent of the ST-elevation myocardial infarction described since 2008.
A 71 year old male patient was admitted to our emergency deparment with a symptom of speech disorder and later angina. We also detected myocardial infarction with de Winter wave in the patient. In the coronary angiography of the patient, we demonstrated the presence of acute thrombus in the circumflex artery, which is much less common in the literature.
Early diagnosis is very important in this acute coronary syndrome that develops without ST elevation. We think that the speech disorder and feeling of worsening in our patient progressed as a result of a vital dystrhythmia that occured before coming to our emergency deparment. Widespread ischemic changes in magnetic resonance imaging in the flair phase may be caused by brain hypoperfusion due to this dysrhythmia. Coronary angiography should be planned for these patients.

Keywords

De Winter wave, myocardial infarction, speech disorder

Supporting Institution

None

Project Number

None

Thanks

None

Konuşma Bozukluğu ile Gelen ST Segment Elevasyonu Ekivalanı Olan De Winter Dalgası; Bir Vaka Raporu

Abstract

Akut koroner sendrom acil koroner girişim gerektirebilen bir klinik tablodur. En önemlisi de ST elevasyonlu miyokardiyal infarktüstür. Yeni gelişen klinik çalışmalar artık ST elevasyonu olmadan ST elevasyonlu miyokardiyal infarktüs ekivalanlarını göstermektedir. De Winter dalgası 2008 yılından beri tanımlanmış ST elevasyonlu miyokard infarktüsünün ekivalanı olarak kabul görmektedir.
71 yaşında acilimize konuşma bozukluğu ve ilerleyen süreçte anjina şikayeti gelişen hastada de Winter dalgalı miyokard infarktüsü tespit ettik. Hastanın yapılan koroner anjiografisinde literatürde çok daha nadir bildirilen sirkumfleks arterdeki akut trombüs varlığını gösterdik.
ST elevasyonu olmadan gelişen bu akut koroner sendromda erken tanı çok önemlidir. Hastamızda gelişen konuşma bozukluğu ve fenalaşma hissinin acilimize gelmeden önce gelişen hayati bir distritmi sonucu geliştiğini düşünmekteyiz. Flair fazdaki manyetik görüntülemedeki yaygın iskemik değişiklikler bu disritmiye bağlı beyin hipoperfüzyonundan kaynaklanabilir. Bu hastalara mutlaka koroner anjiografi planlanmalıdır.

Keywords

De Winter Dalgası, Miyokard infarktüsü, Konuşma Bozukluğu

Project Number

None

References

• 1. De Winter RJ, Verouden NJ, Wellens HJ, et al. A new ECG sign of proximal LAD occlusion. N Engl J Med 2008; 359: 2071–3.
• 2. Zhan Z-Q, Li Y, Han L-H, Nikus KC, Birnbaum Y et all. The de Winter ECG pattern: Distribution and morphology of ST depression. Ann Noninvasive Electrocardiol 2020; 25: e12783.
• 3. Morris NP, Body R. The de Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. Eur J Emerg Med 2017; 24: 236–42.
• 4. Raja JM, Nanda A, Pour-Ghaz I, Khouzam RN. Is early invasive management as ST elevation myocardial infarction warranted in de Winter’s sign? -a “peak” into the widow-maker. Ann Transl Med 2019; 7: 412-7.
• 5. Ahmadi M, Khameneh-Bagheri R, Vojdanparast M, Jafarzadeh-Esfehani R. Wolff-Parkinson-White syndrome and de Winter patterns; An implication for paying special attention to electrocardiogram. ARYA Atheroscler 2019; 15: 201-4.
• 6. Xu J, Wang A, Liu L, Chen Z. The de winter electrocardiogram pattern is a transient electrocardiographic phenomenon that presents at the early stage of ST-segment elevation myocardial infarction. Clinical Cardiology 2018; 41: 1177–84.
• 7. Lin Y-Y, Wen Y-D, Wu G-L, Xu X-D. De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases. World J Clin Cases 2019; 26: 3296-302.
• 8. Liu L, Wang D. A rare transitory change of the De Winter ST/T-wave complex in a patient with cardiac arrest A case report. Medicine 2020; 99: e20133.
• 9. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127: e362-425.
• 10. Shao D, Yang N, Zhou S, Cai O, Zhang R et al. The “criminal” artery of de Winter may be the left circumflex artery A CARE-compliant case report. Medicine 2020; 99: e20585.
• 11. Alahmad Y, Sardar S, Swehli H. De Winter T-wave Electrocardiogram Pattern Due to Thromboembolic Event: A Rare Phenomenon. Heart Views 2020; 21: 40–4.