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).