Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 2 2024 04 30 136 140 Dita Aulia Rachmi Department of Cardiology and Vascular Medicine, Dr Soetomo General Hospital, Universitas Airlangga Faculty of Medicine, Surabaya, Indonesia. Eka Prasetya Budi Mulia 1-Department of Cardiology and Vascular Medicine, Dr Soetomo General Hospital, Universitas Airlangga Faculty of Medicine, Surabaya, Indonesia. 2-Department of Cardiology and Vascular Medicine, Dr R. Soetrasno General Hospital, Rembang, Indonesia. Rosi Amrilla Fagi Department of Cardiology and Vascular Medicine, Dr Soetomo General Hospital, Universitas Airlangga Faculty of Medicine, Surabaya, Indonesia. 2023 09 02 2024 04 25 Various ECG patterns can help determine the location of the occluded coronary artery and the extent of threatened myocardium. The reported positive predictive value for de Winter ECG in predicting acute left anterior descending artery occlusion is inconsistent. Additionally, the morphology of ST depression and other ECG findings may have varying degrees of severity and prognostic significance. This case demonstrates the importance of integrating multiple ECG findings, such as ST elevation, Q waves, and the R/S ratio, with the location of the de Winter pattern on various ECG leads to accurately predict the culprit artery and assess the anatomical extent of myocardial ischemia. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1926