The de winter electrocardiographic pattern: What else do we need to learn?

Velibey, Yalçın; Genç, Duygu; İnan, Duygu; Tezen, Ozan

doi:10.4103/ijca.ijca_9_19

Cited by 5 publications

(4 citation statements)

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“…In light of the existing data, we postulate that in our case by the time our patient presented to the emergency room, the de Winter ST depressions had already been evolving to the concave ST elevations, leading to an atypical presentation of the de Winter pattern rather a classical presentation. We also hypothesize that the tall, symmetric, T-waves seem to be the most characteristic of de Winter syndrome as well as ischemia as that seems to be the persistent finding in cases that report atypical presentations [ 3 , 13 , 15 ]. We contribute to the existing data by reporting a case of critical LAD stenosis which presented as an atypical de Winter pattern and led to a delayed diagnosis and attest to the lack of awareness of this ECG pattern among physicians.…”

Section: Discussionmentioning

confidence: 94%

“…It has also been described that ST elevations can evolve into de Winter ECG pattern [ 12 ]. Hence, based on the existing data, two patterns of de Winter have been proposed [ 3 , 13 ], namely, static presentation with persistent J-point depression before revascularization, and a dynamic pattern that may evolve into ST elevation. Furthermore, recent reports of atypical presentations of de Winter have been published.…”

Section: Discussionmentioning

confidence: 99%

“…Paixão-Ferreira et al reported an atypical presentation of de Winter with a downsloping ST-segment depression in leads V2-V3 (and, to some extent, in V1) with an absence of significant ST-segment elevation in lead aVR [ 14 ]. Similarly, another case report described a de Winter pattern characterized by prominent T-waves and downsloping ST-segment depression in leads V3-V6, along with mild ST-segment depression in the inferior leads in a young male [ 13 ]. Interestingly, an acute right coronary artery occlusion was described with a typical de Winter pattern in the inferolateral leads with upsloping ST-segment depression at the J-point continuing into positive symmetrical T-waves in leads II, III, aVF, and V4-V6, coupled with ST-segment elevation in lead aVR [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Atypical de Winter Presentation of Critical Left Anterior Descending Coronary Artery Occlusion

Kainat¹,

Ain²,

Boricha³

et al. 2022

Cureus

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A 69-year-old male presented with substernal chest pain that started a few hours earlier. On arrival, the patient was hemodynamically stable, and the physical examination was unrevealing. Laboratory workup revealed an elevated high-sensitivity troponin, and an initial electrocardiogram (ECG) revealed tall, symmetric T-waves with preceding minor concave ST-segment elevations less than 1 mm in the precordial leads (V1-V6) and 0.5 mm ST elevation in the aVR. Due to concerning ECG changes, the patient was treated for a possible non-ST-segment elevation myocardial infarction. A loading dose of aspirin and clopidogrel was given and a heparin drip was initiated. However, the patient’s chest pain persisted requiring multiple sublingual nitroglycerin tablets. Later, on further review of the ECGs, the presence of de Winter T-waves was noted and led to activation of the catheterization laboratory, and an urgent left heart catheterization (LHC) was done. LHC revealed a critical 90% occlusion of the left anterior descending artery, and a drug-eluting stent was placed. The patient had a good recovery thereafter. This case emphasizes the rarity of the case and lack of awareness about the atypical de Winter pattern that is considered to be an ST-segment elevation myocardial infarction equivalent. Failure to recognize this can potentially lead to delayed intervention.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Atypical de Winter Presentation of Critical Left Anterior Descending Coronary Artery Occlusion

Kainat¹,

Ain²,

Boricha³

et al. 2022

Cureus

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show abstract

“…In the lack of ST elevation in ECG, there may be some patterns that require emergent angiography [ 2 ]. Understanding de Winter ECG patterns as an ST-elevation myocardial infarction (STEMI) equivalent in cases with suspected acute myocardial infarction is very important, despite its rare incidence, as it indicates an immediate need for emergent revascularization [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

De Winter presentations and considerations: a case series

et al. 2022

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Background The electrocardiogram has a critical role in the diagnosis and risk assessment of patients presenting with chest pain in the emergency ward. Case presentation We present 11 Iranian patients with diagnosis of de Winter referred to our center. Right coronary artery involvement was seen in four cases, left circumflex artery in three cases, proximal left anterior descending artery in two cases, and middle left anterior descending artery in seven cases. We present the case of a 52-year old Iranian male patient in detail. Conclusion Recognizing the electrocardiogram of de Winter as an ST-elevation myocardial infarction equivalent in cases with suspected acute infarction is very important.

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The de Winter pattern in a single precordial lead caused by high-grade stenosis of the proximal left anterior descending artery with plaque rupture: A case report

Song,

Huo,

et al. 2024

Heliyon

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The de winter electrocardiographic pattern: What else do we need to learn?

Cited by 5 publications

References 0 publications

Atypical de Winter Presentation of Critical Left Anterior Descending Coronary Artery Occlusion

Atypical de Winter Presentation of Critical Left Anterior Descending Coronary Artery Occlusion

De Winter presentations and considerations: a case series

The de Winter pattern in a single precordial lead caused by high-grade stenosis of the proximal left anterior descending artery with plaque rupture: A case report

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