case_images: PMC5914128_01
case_images: Initial ECG showing >1 mm upsloping ST depression with symmetric tall T in lead V2-6 characteristic of de Winter ECG pattern.
case_images: CRIC2018-6868204.001.jpg
case_images: PMC5914128_01_CRIC2018-6868204.001.jpg
case_images: fig1
case_images: ECG showed sinus rhythm of 57 bpm and >1 mm upsloping ST depression with symmetric tall T in lead V2-3 characteristic of de Winter T-wave ECG pattern (Figure 1).
case_images: ECG showing progression into ST-segment elevation myocardial infarction.
case_images: CRIC2018-6868204.002.jpg
case_images: PMC5914128_01_CRIC2018-6868204.002.jpg
case_images: fig2
case_images: ECG was done 3 hours later showing Q-waves developing in V2-4, consistent with the final stages of acute STEMI accompanied with ST-segment elevation in lead V2-4 which barely meets the 2 mm threshold for those precordial leads as per the guidelines (Figure 2). Elevated troponin at the 5th hour confirmed the presence of myocardial infarction.
case_images: ECG after fibrinolysis showing resolution of ST-segment elevation.
case_images: CRIC2018-6868204.003.jpg
case_images: PMC5914128_01_CRIC2018-6868204.003.jpg
case_images: fig3
case_images: Streptokinase (1.5 million units) was administered, and chest pain subsided with a resolution of ST-segment elevation (Figure 3).