A rare transitory change of the De Winter ST/T-wave complex in a patient with cardiac arrest

Abstract

Rationale: The De Winter ST/T-wave complex is a rare and special electrocardiogram (ECG) manifestation in some patients with a total or subtotal occlusion in the proximal left anterior descending (LAD) coronary artery. It mainly appears as an ST-segment superior oblique depression instead of an ST elevation. However, a transitory change of the De Winter ST/T-wave complex has not been reported previously. Patient concerns: A 40-year-old man developed sudden precordial dull and unrelieved pain. One hour later, he suddenly lost consciousness when he arrived at the emergency department. After successful cardiopulmonary resuscitation (CPR), 2 ECGs were taken at 22-minute interval, which showed completely different manifestations. The first ECG showed acute inferior-wall ST elevation myocardial infarction (STEMI), while the second ECG showed a De Winter ST/T-wave complex, which indicated acute anterior-wall myocardial infarction. Diagnosis: The patient was diagnosed with acute myocardial infarction. Interventions: The patient responded to urgent treatment by percutaneous coronary intervention (PCI). Outcomes: It was confirmed that the case was consistent with the main characteristics of a De Winter ST/T-wave complex after PCI. The first ECG was a rare transitory change of the De Winter ST/T-wave complex. The patient was well recovered and discharged. Lessons: The De Winter ST/T-wave complex is an extremely dangerous and rare ECG manifestation that is not widely recognized at present. Although the mechanism is not very clear, it should be considered as indicating an equivalent risk of STEMI because it may suggest total or subtotal occlusion in the proximal LAD coronary artery. It is believed that in the near future, the mechanism of ECG including its transitory changes, will be fully revealed.

Konuşma Bozukluğu ile Gelen ST Segment Elevasyonu Ekivalanı Olan De Winter Dalgası; Bir Vaka Raporu

“…In other case reports, it was observed that a patient with the Winter pattern transformed into STEMI, and a patient with STEMI turned into Winter wave. This situation is thought to be caused by the thrombus in the artery that does not cause full-thickness occlusion or the thrombus undergoes spontaneous lysis (7,8). In our case, our patient previously had a syncope described as a speech disorder and deterioration.…”

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

“…The de Winter ECG pattern was initially described as a static ECG persisting from the time of the first ECG until the preprocedural ECG and was exclusively associated with LAD occlusion. In recent years, several reports have observed this ECG pattern in occlusions of arteries other than the LAD, such as the RCA (Tsutsumi & Tsukahara, 2018 ), the first diagonal branch (Montero Cabezas et al, 2016 ), the obtuse marginal artery (Xu et al, 2019 ), and the LM (Kashou et al, 2020 ; Liu & Wang, 2020 ; Sunbul et al, 2015 ). The location of the upsloping STD in the precordial leads seemed to be associated with the culprit artery.…”