Background: A ‘STEMI equivalent’ electrocardiogram (ECG) pattern describes an acute thrombotic occlusion of a large coronary artery without ST-segment elevation. This pattern must be recognized and treated with emergent reperfusion therapy. De Winter syndrome is a special ECG pattern reflecting acute occlusion in the proximal segment of LAD (left anterior descending) coronary artery and a primary percutaneous coronary intervention (PCI) should be performed as early as possible.Case illustration: We present two patients admitted to the emergency department with symptoms of chest pain. Their ECGs revealed de-Winter T waves and then coronary angiography was performed. Total occlusion in the proximal segment of the LAD coronary artery was observed in both patients, and stents were implanted to the culprit lesion. Both ECG patients show an up-sloping ST-segment depression (STD, >1 mm) starting from the J-point, with symmetrical, tall and significant T-waves in the precordial leads. This ECG pattern indicates a LAD coronary artery obstruction. The ‘de Winter’ ECG pattern is not mentioned in the ESC guidelines, but it is essential to recognize this rare ECG pattern as the STEMI equivalent, and it must be treated with prompt revascularization therapy.Conclusion: The ‘de Winter’ ECG pattern, as other ‘STEMI equivalent’, must be recognized promptly and treated as soon as possible with emergent reperfusion by percutaneous coronary intervention.

Background: Pre-eclampsia is a common condition that causes significant morbidity and mortality in pregnant women; the occurrence of cardiovascular complications aggravates the disease. Efforts have been made to predict the complications of pre-eclampsia, but some modalities, such as echocardiography and biomarkers, are neither available nor widely feasible for use by healthcare providers, especially in developing countries. On the other hand, ECG is cheap, noninvasive, widely available, and already routinely performed for pre-eclampsia. The role of ECG in predicting cardiovascular complications in pre-eclampsia patients is not known. Objective: This study aimed to investigate the role of ECG in pre-eclampsia diagnostics and simple clinical parameters in pre-eclampsia patients with and without cardiovascular complications. Methods: This cross-sectional, analytical study used retrospective data from medical records of patients with pre-eclampsia from the Dr Kariadi General Hospital, Semarang, Indonesia, from January 2016–July 2017. Bivariate association between demographic, clinical, laboratory, and ECG results with the occurrence of cardiovascular complications was tested; this continued with logistic regression. Results: Sixty-eight pre-eclampsia patients were identified, with a mean age of 30.2 years. Cardiovascular complications occurred in 16 patients (23.5%), with 14 patients exhibiting pulmonary oedema. In univariate analysis, haemoglobin level and heart rate showed a significant association with the occurrence of cardiovascular complications (p=0.035 and 0.033, respectively). No significant independent predictor was found in multivariate analysis. Conclusion: This study showed that ECG parameters were not able to predict cardiovascular complications in pre-eclampsia patients. Nevertheless, there was a significant association between heart rate and haemoglobin level with cardiovascular complications in pre-eclampsia.