Case Presentation
A 53-year-old male presented to the emergency department with oppressive
chest pain and diaphoresis, which had been persistent for 2 hours. In
addition, an initial 18-lead ECG was performed immediately on admission
(Figure1).
The patient’s initial ECG on admission revealed a sinus rhythm of 75
beats /min, with upsloping ST-segment depression at the J waves
continuing into tall positive T waves in leads V4 to V6, coupled with
upsloping ST-segment elevation in leads V1 to V3, slight ST-segment
elevation in lead aVR, and Q waves in leads V3 and V4. There exist deep
q waves (<0.04 msec) in inferior leads without ST-T changes.
The ECG showed both de Winter like ECG pattern and J waves, which show
close association with acute occlusion of the proximal left anterior
descending coronary artery (LAD) and sudden cardiac death. An emergent
coronary angiography was performed immediately, presenting an occlusion
of the proximal-LAD (thrombolysis in myocardial infarction 0-graded
flow, TIM-0) (Figure2, A) and an approximately 90% stenosis in the
middle-distal site of the right coronary artery (RCA) (Figure2, B). The
culprit lesion (the proximal-LAD) was successfully dilated. Meanwhile, a
2.75 × 23mm drug-eluting stent was placed with good angiographic results
(TIM-3) (Figure2, C). The patient’s symptoms were getting better after
the operation. Peak cardiac-specific troponin T (cTnT) was 6679 ng/L
(normal range is 0-14ng/L). The second ECG was recorded at 2 hours after
stent implantation (Figure3).