Acute coronary syndrome is a clinical condition that may require urgent coronary intervention. The most important is myocardial infarction with ST elevation. Emerging clinical studies now show equivalents of ST elevation myocardial infarction without ST elevation. The de Winter wave has been recognized as the equivalent of the ST-elevation myocardial infarction described since 2008. A 71 year old male patient was admitted to our emergency deparment with a symptom of speech disorder and later angina. We also detected myocardial infarction with de Winter wave in the patient. In the coronary angiography of the patient, we demonstrated the presence of acute thrombus in the circumflex artery, which is much less common in the literature. Early diagnosis is very important in this acute coronary syndrome that develops without ST elevation. We think that the speech disorder and feeling of worsening in our patient progressed as a result of a vital dystrhythmia that occured before coming to our emergency deparment. Widespread ischemic changes in magnetic resonance imaging in the flair phase may be caused by brain hypoperfusion due to this dysrhythmia. Coronary angiography should be planned for these patients.
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