De Winter Electrocardiographic Pattern Related with a Non‐Left Anterior Descending Coronary Artery Occlusion

Abstract

The electrocardiographic pattern consisting of ST-segment depression and hyperacute T waves in patients with acute chest pain, known as "De Winter pattern," has been related with the occlusion of the proximal left anterior descending artery (LAD). The association of these findings with the involvement of a different coronary artery has not been described. We present a 53-year-old patient with an occlusion of the first diagonal branch and an electrocardiogram showing a "De Winter pattern." The reported case demonstrates that "De Winter pattern" is not exclusively associated with the occlusion of the proximal segment of the LAD.

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.…”

Dynamic evolvement of the de Winter ECG pattern

“…The de Winter ECG pattern, known as a STEMI equivalent, accounts for 2% of patients with occlusion in the proximal LAD artery (Verouden et al, 2009). Recently, occlusions in the right coronary artery (RCA), a diagonal branch artery, and obtuse marginal artery, associated with this ECG pattern, have been reported (Karna et al, 2019;Montero Cabezas et al, 2016;Xu et al, 2019).…”

“…These patterns were once considered static and persistent, from the initial ECG until revascularization of the occluded vessel occurs. Recently, some reports have revealed a dynamic evolution of the de Winter ECG pattern (Montero Cabezas et al., 2016; Xu et al., 2019). However, to the best of our knowledge, this case is the first presentation in which the de Winter ECG pattern could progress to STEMI and then STEMI transformed into a normal ECG pattern.…”

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

“…6 This condition is also associated with occlusion of a gigantic obtuse marginal artery in the lateral and inferior leads, 7 obstruction of the left main coronary artery (LMCA) in leads V3/V4 to V6, 8,9 or with first diagonal branch occlusion with involvement of leads V2 to V5. 10 However, the de Winter ECG pattern in leads V2 to V4 is a rare manifestation of acute LMCA occlusion. We present a case of a patient with the de Winter ECG pattern in leads V2 to V4 by LMCA occlusion.…”