Rare ECG Dynamics in Acute Coronary Syndrome: Co-Occurrence of De Winter and Wellens' Signs in Proximal LAD Occlusion

The present study explores about rare ECG Dynamics in Acute Coronary syndrome. De Winter sign and Wellens sign are two electrocardiogram patterns which have been described in acute coronary syndrome due to acute occlusion of left anterior descending coronary artery. A 69-year-old male with cardiovascular risk factors including hypertension, diabetes mellitus and a sedentary lifestyle presented with typical rest angina lasting more than 20 minutes. Initial ECG taken at nearby hospital showed de Winter’s pattern. Wellens’ syndrome has been described as occurring in 14% to 18% of patients with unstable angina 3,4, while the de Winter pattern is known to be in 2% of patients admitted with anterior wall infarction5. The coexistence of the De Winter and Wellens patterns in the same patient is an extremely rare finding.