A de Winter electrocardiographic pattern caused by left main coronary artery occlusion: A case report

Abstract

A de Winter electrocardiographic (ECG) pattern comprising precordial junctional ST depression followed by tall, positive symmetrical T waves in leads V1/V2 to V4/V6 is often concomitant with ST elevation in lead aVR. This finding strongly suggests proximal left anterior descending coronary artery occlusion. We described a patient who had the de Winter ECG pattern in leads V2 to V4 by acute left main coronary artery (LMCA) occlusion. The ECG also showed maximal ST depression in leads V4 to V5 and inverted T waves in leads V5 to V6. This finding indicated a global subendocardial ischemia ECG pattern, which suggested LMCA or three-vessel disease. Early recognition of this ECG manifestation is important for averting a disastrous prognosis in acute LMCA occlusion because emergent coronary intervention may be life-saving.

The De Winter‐like electrocardiogram pattern associated with multi‐vessel disease

“…The electrophysiological mechanism of de Winter ECG pattern is unclear. The theoretical explanation of de Winter ECG pattern includes an anatomical variant of the Purkinje fibers with endocardial conduction delay or lack of activation of sarcolemmal adenosine triphosphate‐sensitive potassium channels by ischemic ATP depletion (Zhan et al, 2020a ). This case is classified as a multi‐vessel disease, ischemia mirror reflection may also be one of the reasons for this type of ECG performance.…”

“…However, in recent years, more and more de Winter cases have been reported that diseased vessels are not associated with LAD artery. tion (Zhan et al, 2020a). This case is classified as a multi-vessel disease, ischemia mirror reflection may also be one of the reasons for this type of ECG performance.…”

The de Winter electrocardiographic pattern evolves to ST elevation in acute total left main occlusion: A case series

“…Tsutsumi K (Tsutsumi & Tsukahara, 2018 ) reported a case of a de Winter pattern in leads II, III, aVF, and V 4 –V 6 associated with a predominantly large RCA culprit in an inferoposterior myocardial infarction. Zhong‐Qun Zhan reported that the de Winter ECG pattern in leads V 2 –V 4 with concomitant STD and inverted T waves in leads V 5 –V 6 was associated with acute LM occlusion (Zhan et al, 2020 ). Our cases indicated that a widespread upsloping STD in V 2 –V 6 and inferior leads, with the strongest STD centered around V 5 , may indicate global subendocardial ischemia, suggesting total LM occlusion.…”

De Winter Pattern: An Important Electrocardiographic Sign Not to be Missed

“…This is in line with another case report of de Winter ECG pattern in a patient with a total occlusion of the LMCA. 5 Despite its rarity in day-to-day practice, physicians should be familiar with this type of ECG pattern and have a high index of suspicion to prevent any treatment delay.…”