Two successive electrocardiograms of an old male with acute myocardial infarction: What on earth was going on?

Abstract

A 68-year-old male complained of a sudden 2-h chest pain accompanied by dizziness and diaphoresis. His consciousness lost several times because of ventricular fibrillation attack. Emergent CAG showed proximal left anterior descending (LAD) occlusion, but two previous successive electrocardiograms established diagnoses of non-ST-elevation myocardial infarction (NSTEMI) and STEMI respectively, indicating that the patient had experienced acute subtotal occlusion of proximal LAD to total occlusion of the left main coronary trunk (LMT). It is vital to identify de Winter pattern associated with proximal LAD lesion in view of the potential circulatory collapse, fatal arrhythmias and sudden cardiac death from it.