Abstract：
The Dressler-de Winter sign is an electrocardiogram (ECG) pattern characterized by upsloping ST-segment depression in leads V1-V6 followed by tall, hyperacute T waves, typically indicating an occlusion of the left anterior descending artery (LAD). We present a case involving an inferoposterior ST-segment elevation myocardial infarction (STEMI) with a variant of the de Winter sign, a concept of ST-segment continuum in the precordial leads. Despite initial ECG findings suggesting right coronary artery (RCA) or left circumflex artery (LCX) involvement, coronary angiography confirmed occlusion of the wrap-around LAD distal to the first septal (S1) and diagonal branch (D1) and revealed a left dominant system accompanied by a small non-dominant RCA. This case highlights the diagnostic complexity in accurately localizing the culprit artery in STEMI cases exhibiting the de Winter sign. Understanding such ECG variants is crucial for analyzing the mechanisms of acute ischemia and ensuring accurate assessment of the culprit vessel for effective revascularization.
摘要：
Dressler-deWinter标志是一种心电图（ECG）模式，其特征是V1-V6导联上斜的ST段压低，然后是高，超急性T波,通常表明左前降支动脉（LAD）闭塞。我们介绍了一例涉及后部ST段抬高性心肌梗死（STEMI）的病例，该病例具有deWinter体征的变体，心前导联ST段连续体的概念。尽管最初的心电图结果提示右冠状动脉（RCA）或左回旋支动脉（LCX）受累，冠状动脉造影证实第一间隔（S1）和对角分支（D1）远端环绕的LAD闭塞，并显示左侧优势系统伴有小的非优势RCA。此病例凸显了在表现出deWinter体征的STEMI病例中精确定位罪魁祸首动脉的诊断复杂性。了解此类ECG变体对于分析急性缺血的机制和确保准确评估罪犯血管以进行有效的血运重建至关重要。
