de winter sign: A masquerading electrocardiogram in ST-elevation myocardial infarction

Electrocardiogram (ECG) is usually the first and most important test in patients with acute coronary syndrome which helps to diagnose as well as classify patients into ST elevation or non-ST elevation myocardial infarction (STEMI). This classification is important as both the groups differ in their pathophysiology as well as management. Patients with STEMI require urgent reperfusion therapy either with percutaneous coronary intervention or fibrinolysis, if the earlier is not available. They may, however, sometimes present without obvious ST elevation in ECG resulting in delayed diagnosis and reperfusion therapy. Identification of such STEMI equivalents, therefore, becomes very important for physicians as well as interventional cardiologists. We report a 62-year-old male who presented without an obvious ST elevation in ECG and subsequently found to be having acute obstruction of mid-left anterior descending artery.