Identification of the STEMI-equivalent de Winter Electrocardiogram Pattern After Ventricular Fibrillation Cardiac Arrest: A Case Report

Carr, Michael J.; O'Shea, James T.; Hinfey, Patrick

doi:10.1016/j.jemermed.2016.03.022

Cited by 11 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This non--concave morphology, in the right clinical setting, is 97% specifi c for identifying STE morphology in AMI. Lastly, while hyperacute T waves pattern in anterior precordial leads have often been described, 11,12 to our knowledge a so impressive high amplitude dynamic T-waves pattern in all inferior leads, related with thrombotic acute occlusion in the RCA, is not so frequently reported and therefore it is important for the emergency physicians and cardiologists to recognize this high-risk ECG marker of STEMI.…”

Section: Discussionmentioning

confidence: 93%

Hyperacute T waves in inferior leads as a dynamic sign of evolving STEMI

2019

View full text Add to dashboard Cite

Úvod: Elektrokardiogram (EKG) je běžně používaným nástrojem v diagnostice akutního infarktu myokardu. Mezi EKG známky akutní ischemie myokardu mohou jako nejčasnější a jediná EKG známka infarktu myokardu s elevacemi úseku ST (STEMI) patřit vysoké a široké vlny T, označované rovněž jako hyperakutní vlny T. Cíl: Zdůraznit význam časného rozpoznání hyperakutních vln T jako ekvivalentu STEMI s cílem zabránit dalšímu poškození myokardu odpovídající léčbou. Kazuistika: Na oddělení urgentního příjmu byla pro bolest na hrudi dopravena 65letá žena. Vyšetření EKG prokázalo přítomnost vysokých a širokých T vln ve spodních svodech, inverzi T vlny ve svodech D 1-aVL a depresi úseku ST ve svodech V 4-V 5-V 6. Bolest na hrudi téměř úplně vymizela po podání kyseliny acetylsalicylové, ticagreloru a sublingválním užití nitroglycerinu; zároveň došlo k vymizení vysokých vln T a zmírnění deprese úseku ST ve svodech V 4-V 5-V 6. Přibližně o 15 minut později došlo u pacientky k recidivě bolesti na hrudi s následnou těžkou hypotenzí a sinusovou bradykardií. Emergentní koronarografi cké vyšetření prokázalo kompletní trombotický uzávěr středního segmentu pravé koronární tepny (RCA). Byla provedena balonková angioplastika s umístěním lékového stentu v postižené tepně. Závěr: Hyperakutní vysoké a široké symetrické vlny T jsou přechodné, a nejsou tedy častým jevem, mohou však představovat první EKG důkaz úplného uzávěru koronární tepny a transmurální ischemie. Časné rozpoznání tohoto tvaru EKG křivky je naprosto nezbytné pro stanovení diagnózy a optimální léčbu pacientů se STEMI, založenou na okamžité reperfuzi primární angioplastikou.

show abstract

Section: Discussionmentioning

confidence: 93%

Hyperacute T waves in inferior leads as a dynamic sign of evolving STEMI

2019

View full text Add to dashboard Cite

show abstract

“…A total of 51 out of 86 articles included 83 patients ( Ahmadi, KhamenehBagheri, Vojdanparast, & Jafarzadeh‐Esfehani, 2019; Canakci, Turgay, Acar, & Mert, 2018; Carr, O'Shea, & Hinfey, 2016; Carrington, Santos, Picarra, & De, 2018; Chen, Wang, & Huang, 2020; de Winter, Adams, & Amoroso, 2019; Fiol Sala, Bayés de Luna, Carrillo López, & García‐Niebla, 2015; García‐Izquierdo, Parra‐Esteban, Mirelis, & Fernández‐Lozano, 2018; Giovanni & Francesco, 2020; Goktas, Sogut, Yigit, & Kaplan, 2017; Grandjean, Degrauwe, Tessitore, & Iglesias, 2019; Hanna & Glancy, 2016; He, Liu, & Wang, 2020; Hennings & Fesmire, 2012; Karna, Chourasiya, Chaudhari, Bakrenia, & Patel, 2019; Lam, Cheung, Wai, Wong, & Tse, 2019; Li, Li, Man, Li, & Long, 2019; Lin, Wen, Wu, & Xu, 2019; Mahajan, Batra, & Gupta, 2018; Martínez‐Losas & Fernández‐Jiménez, 2016; Massobrio, Scarrone, & Valbusa, 2016; Montero Cabezas, Karalis, & Schalij, 2016; Montero‐Cabezas, van‐der‐Kley, Karalis, & Schalij, 2015; Niimi, Ooka, Shiraishi, & Fukuda, 2019; Patel, Baker, Paterick, & Tajik, 2017; Pica, Ballestrero, Pistis, & Crimi, 2016; Pranata, Huang, & Damay, 2018; Qayyum, Hemaya, Squires, & Adam, 2018; Qu, Tao, & Liu, 2019; Rao, Wang, & Zhang, 2018; Rodrigues, Gomes, Drumond, & Pereira, 2016; Samadov, Akaslan, Cincin, Tigen, & Sarı, 2014; Sunbul, Erdogan, Yesildag, & Mutlu, 2015; Thabouillot, Bouvier, & Roche, 2017; Tsutsumi & Tsukahara, 2018; Verouden et al., 2009; Viejo‐Moreno, Rubio‐Muñoz, Cabrejas‐Aparicio, & Novo‐García, 2018; Viejo‐Moreno, Rubio‐Muñoz, Cabrejas‐Aparicio, & Novo‐García, 2018; de Winter, Adams, Verouden, & de Winter, 2016; de Winter et al., 2008; Xu, Wang, Liu, & Chen, 2018; Xu, Jiang, & Feng, 2018; Xu, Lu, & Jin, …”

Section: Resultsmentioning

confidence: 99%

The de Winter ECG pattern: Distribution and morphology of ST depression

Zhong-qun

Han

et al. 2020

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Background The reported positive predictive value (PPV) for the “de Winter ECG pattern” to predict an acute left anterior descending artery (LAD) lesion is inconsistent. Besides, the morphology of upsloping or nonupsloping ST depression (STD) may have different significance of severity and prognostication. Methods We searched the MEDLINE database using “de Winter” or “junctional ST‐depression with tall symmetrical T‐waves” or “tall T wave” or “STEMI equivalent” as the item up to March 2020. We compared the ECG differences between the different culprit arteries and various morphological STD. Results A total of 70 patients with analyzable ECGs were included. In 60 patients (LAD group), the LAD was the culprit artery, while in 10 patients (non‐LAD group), there were other etiologies. Maximal STD in V2 or V3 had a PPV of 89% of all patients and 98% of patients without ST elevation in V2 to detect an acute LAD lesion. The presence of q/Q‐wave or poor R‐wave progression in the precordial leads was significantly more often found in patients with upsloping STD than in patients with nonupsloping STD in the LAD group (84% vs. 27%, p < .01). In 18 patients, the ECG showed a change from upsloping to nonupsloping STD from the leads with maximal STD to the surrounding leads with less STD. Conclusions The location of the maximal STD in the precordial leads differs between patients with LAD as the culprit artery and other etiologies of the de Winter ECG pattern. Upsloping STD signifies more severe signs of ischemia than nonupsloping STD.

show abstract

“…Despite that, the misdiagnosis rate is still extremely high among clinicians because of the atypical pattern, and it is often classified as NSTEMI which may result in missing the appropriate therapeutic window for revascularization. 7 A systemic review by Joel et al concluded early activation cardiac catheterization lab with PCI leads to better clinical outcomes. 8 However, with the majority cardiovascular burden in middle-income to poor-income countries, accessing the cardiac catheterization laboratory within the therapeutic window for revascularization can be a great challenge.…”

Section: Discussionmentioning

confidence: 99%

de Winter syndrome, a STEMI-equivalent ECG pattern leading to life-threatening arrhythmia: A case report from a non-cardiac catheterization laboratory hospital

Parthiban

Sani

2022

Proceedings of Singapore Healthcare

View full text Add to dashboard Cite

de Winter syndrome is a rare but important electrocardiographic pattern to recognize in patients presenting with chest pain. Under-recognition and delayed revascularization in patients with de Winter syndrome may lead to poor clinical outcomes. Despite increasing evidence of its association with total occlusion of the left anterior descending artery, the role of thrombolysis in the absence of percutaneous coronary intervention is not specifically addressed in recent international guidelines. Herein, we report a case of a 50-year-old gentleman with no known medical illness who presented with excruciating chest pain associated with diaphoresis, nausea, and reduced effort tolerance. Clinical examination revealed a distressed patient with bibasal crepitations with no other significant findings. The first ECG was sinus bradycardia with poor R-wave progression. ECG repeated 6 h later revealed de Winter syndrome. Within minutes, the patient developed sustained pulse ventricular tachycardia requiring synchronized cardioversion. The patient was intubated for impending cardiorespiratory failure. We took the pharmacoinvasive approach. The patient received thrombolytic therapy as percutaneous coronary intervention (PCI) was not available and transferring to the nearest cardiac center was not possible within the therapeutic window. He was then subsequently transferred to the nearest cardiac center post thrombolysis for PCI. We report this case study to highlight the importance of recognizing this STEMI-equivalent ECG pattern in patients presenting with chest pain, and call for randomized control trials to evaluate the effectiveness of thrombolytic therapy as an alternative emergent reperfusion strategy in de Winter syndrome in non-cardiac centers.

show abstract

Identification of the STEMI-equivalent de Winter Electrocardiogram Pattern After Ventricular Fibrillation Cardiac Arrest: A Case Report

Cited by 11 publications

References 8 publications

Hyperacute T waves in inferior leads as a dynamic sign of evolving STEMI

Hyperacute T waves in inferior leads as a dynamic sign of evolving STEMI

The de Winter ECG pattern: Distribution and morphology of ST depression

de Winter syndrome, a STEMI-equivalent ECG pattern leading to life-threatening arrhythmia: A case report from a non-cardiac catheterization laboratory hospital

Contact Info

Product

Resources

About