de Winter syndrome

Martínez-Losas, Pedro; Fernández‐Jiménez, Rodrigo

doi:10.1503/cmaj.150816

Cited by 17 publications

(17 citation statements)

References 2 publications

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“…The de Winter ECG pattern (ST-segment upsloping depression and tall, positive symmetrical T waves; ST-elevation (1–2 mm) in lead aVR; a loss of precordial R-wave progression; and QRS complexes not widened or slightly widened) was first described by de Winter in 2008[1]. The key diagnostic features of the de Winter ECG pattern include the follow two points: (A) ST-segment upsloping depression > 1 mm with tall and positive symmetrical T waves in the precordial leads; and (B) ST-segment elevation in the aVR lead[2-4]. The previous view of this ECG pattern was that it is static and indicates complete proximal LAD occlusion[1,4].…”

Section: Discussionmentioning

confidence: 99%

De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

Lin¹,

Wen²,

Guo-lin³

et al. 2019

WJCC

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BACKGROUNDThe de Winter electrocardiography (ECG) pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain. The previous view was that the de Winter ECG pattern is static.CASE SUMMARYA 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min. The first ECG showed only T-wave inversion in III and aVF leads. Another ECG was performed at the 100th minute, showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads; the J point was raised by 0.1 mV at the aVR lead. The patient was referred to our catheterization laboratory. A third ECG showed ST segment elevation by 0.2 mV in the I and aVL leads. The patient underwent emergency coronary angiography, which revealed complete proximal left anterior descending coronary (LAD) occlusion. The second patient presented with a 1-h history of sudden-onset, severe, substernal crushing chest pain. The first ECG showed ST-segment elevation (0.1–1.7 mV) in I, aVL, and precordial leads. The patient was referred to the catheterization laboratory. On arrival, his symptoms alleviated, and ECG showed that the ST-segments had significantly fallen back. The third ECG showed a typical de Winter pattern. Coronary angiography revealed 99% stenosis of the middle LAD.CONCLUSIONThe de Winter ECG pattern is transient and dynamic, and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.

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Section: Discussionmentioning

confidence: 99%

De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

Lin¹,

Wen²,

Guo-lin³

et al. 2019

WJCC

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“…Therefore, the therapeutic window might be missed [ 8 ]. Since this type of ECG has no ST-segment elevation, clinicians often have a poor understanding of it, ignoring its risks and categorizing it as NSTEMI, which further delays the diagnosis and treatment [ 9 , 10 ]. Furthermore, in the case reported here, the biomarkers could not be relied upon for the diagnosis of myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

A middle-aged male patient with de Winter syndrome: a case report

Lü

Zhou

et al. 2020

BMC Cardiovasc Disord

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Background De Winter syndrome accounts for approximately 2% of all patients with acute anterior myocardial infarction admitted to the emergency department, and is characterized by severe stenosis of the left anterior descending coronary artery (LAD). The ECG changes are not recognized by ECG software, and poor understanding of the syndrome among physicians may lead to misdiagnosis, delayed reperfusion, and mortality. Case presentation A 51-year-old male patient presented with a newly developed ECG pattern suggestive of de Winter Syndrome. Coronary angiography revealed anterior myocardial infarction. Based on the ECG and clinical manifestations, the patient was diagnosed with de Winter syndrome and underwent timely percutaneous coronary intervention to revascularize the left anterior descending artery (LAD). The patient showed good outcomes and no complications at 4 months after the operation. Conclusions This case highlights the importance of being aware of the possibility of de Winter syndrome in patients with symptoms of myocardial infarction but atypical ECG in order to conduct early revascularization and treatments.

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“…The second one is that the absence of ST-segment elevation is due to delayed activation of potassium channels in the sarcolemma because of acute ischemia with depletion of thiphosphate of adenosine stocks, this way, the repolarization is affected and results in this pattern of ECG [3]. There is controversy in the literature regarding the duration of that pattern, as some authors consider it to be temporary and others as durable, but regardless of duration, the severity of the case is considerable and should be conducted correctly as an emergency [7].…”

Section: Discussionmentioning

confidence: 99%

“…The delay in recognizing this pattern leads to delays in the definitive treatment of these patients, increasing the chances of high morbimortality and future clinical repercussions of high severity, such as cardiogenic shock and heart failure [7].…”

Section: Discussionmentioning

confidence: 99%

Total Occlusion of Anterior Descending Artery (AD) without ST-Segment Elevation: DE Winter Pattern

Alcantara¹,

Filho²,

Lino³

et al. 2018

JPP

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Abstract:The recognition of the presence of ST-segment elevation in the context of ACS (acute coronary syndrome) is fundamental for the good outcome of the case. However, some electrocardiographic patterns have been highlighted by the fact that there is no elevation, but they represent a severity similar to ACS with ST elevation. Hence, it is necessary that doctors who do the first service recognize these standards promptly.The electrocardiographic pattern of association between the ST-segment depression and the hyperacute T waves representing myocardial infarction in the anterior wall, localizing more specifically in the anterior descending artery, now known as the De Winter pattern, was first described by Dressler, and then described by Winter six years later. Winter observed that, out of a series of 1,452 cases, 2% of patients with anterior wall infarction had the pattern of ST-segment depression, positive and symmetrical T waves, and occasionally mild ST-segment elevation at AVR derivation. Those patients are admitted to the emergency room with a typical chest pain. However, because the electrocardiographic findings of this syndrome are not known to many health professionals, in many cases the patients do not receive adequate care and have fatal outcome, since mortality is relevant in these cases. Thus, the rapid recognition of this pattern is extremely necessary for the correct and effective intervention.

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de Winter syndrome

Cited by 17 publications

References 2 publications

De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

A middle-aged male patient with de Winter syndrome: a case report

Total Occlusion of Anterior Descending Artery (AD) without ST-Segment Elevation: DE Winter Pattern

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