Uncommon culprit artery leading to atypical de winter electrocardiographic changes: a case report.

Background: A subset of patients with acute coronary artery occlusion requiring emergency revascularization, does not present with the typical ECG features of ST-segment elevation myocardial infarction (STEMI).Timely identification of these atypical presentations is crucial.

Case Presentation: This report describes a 55-year-old male patient who was admitted to the emergency department with chest pain. The electrocardiogram (ECG) recorded atypical de Winter electrocardiographic changes and their evolution.

Results: Coronary angiography confirmed the occlusion of the second diagonal branch (D2). The patient's condition improved after D2 balloon angioplasty.

Conclusion: De Winter electrocardiographic changes can also be observed in D2 occlusions and may present with milder manifestations. Timely recognition of these changes holds significant clinical value.