De Winter T waves are a rare presentation for patients with acute LAD occlusion, some authors considering this pattern to be an equivalent of anterior ST elevation myocardial infarction (STEMI) 1. We present the case of a 41 years old male presenting with a 3 hours continuous chest pain. The ECG pattern revealed the De Winter pattern with upsloping ST depression (> 1 mm at J-point) in the precordial leads V3-V4 and peaked anterior T waves, with the ascending limb of the T wave commencing below the isoelectric baseline. The biochemical markers of myocardial necrosis were positive. Transthoracic echocardiography (TTE) revealed akinetic interventricular septum (IVS), apex and apical inferior wall with mild-moderate systolic left ventricle (LV) dysfunction. After receiving the guideline recommended antiplatelet and anticoagulant therapy (600mg Clopidogrel, 250 mg Acetyl-salicylic acid (ASA), 100 U/kg unfractionated heparin (UFH) associated with high dose of statin and iv nitrate the patient’s chest pain disappeared. Primary PCI was elected, revealing occlusion of the left descendent artery in the second segment, which was treated with a drug eluting stent angioplasty. The post PCI evolution was favorable with no recurrent chest pain and no signs of heart failure, on classic treatment.