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 the operation), and the patient took a turn to be out of danger.