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Electrocardiogram (ECG) is the most readily available objective data from patients, it contains a wealth of connotation, but rapid and accurate identification of high risk ECG is still a challenge for most practitioners. We present an interesting case with two types high risk ECG patterns, de Winter like ECG pattern and J wave, which implied acute occlusion of coronary artery and sudden cardiac death. The patient was treated promptly and quickly (within 40 min, from first touch to complete thedoi:10.22541/au.164864787.74450275/v1 fatcat:j4ecxw2i6rhkpisqc7w6ezcoye