The “De Winter Pattern” Can Progress to ST-segment Elevation Acute Coronary Syndrome

Sala, Miquel Fiol; Luna, Antonio; López, Andrés Carrillo; García‐Niebla, Javier

doi:10.1016/j.rec.2015.07.006

Cited by 12 publications

(15 citation statements)

References 5 publications

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“…Despite the available literature, it remains an uncommon finding and can be easily overlooked when patients present to the emergency room and causes a delay in activation of the catheterization laboratory. Although initially de Winter pattern was considered a static condition that did not evolve into ST-segment elevation [ 2 , 10 ], it was later described that de Winter ECG could evolve into ST-segment elevations [ 8 , 11 ]. It has also been described that ST elevations can evolve into de Winter ECG pattern [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

Kainat¹,

Ain²,

Boricha³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Our cases indicated that a widespread upsloping STD in V 2 –V 6 and inferior leads, with the strongest STD centered around V 5 , may indicate global subendocardial ischemia, suggesting total LM occlusion. Recent reports have argued that this ECG pattern is not a static but a transient phenomenon that evolves to an ST‐segment elevation myocardial infarction (STEMI) ECG pattern within hours of presentation (Goebel et al, 2014 ), this dynamic change also occurs after STE spontaneously in a typical STEMI before any coronary intervention (Lam et al, 2019 ; Xu et al, 2019 ) or following thrombolytic therapy in anterior STEMI (Fiol Sala et al, 2015 ). Zhong‐Qun Zhan reported that de Winter ECG pattern (in leads V 4 –V 6 ) may evolve to ST elevation accompanied by increased severity of myocardial ischemia in LM dissection (Zhan et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Zhang

et al. 2021

Noninvasive Electrocardiol

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The de Winter electrocardiographic (ECG) pattern was characterized by upsloping STsegment depressions, tall and positive symmetrical T waves in precordial leads. This rare ECG pattern was recognized as an indication of proximal left anterior descending artery occlusion. Less commonly, this ECG pattern was reported in association with occlusion of other coronary artery segments. We present three cases of the de Winter pattern associated with acute total left main occlusion. This pattern may evolve to ST elevation within hours of presentation. Widespread upsloping ST-segment depressions from V 2 -V 6 , centered on V 5 were observed in these patients.

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“…2,3 In the original view, this de Winter ECG pattern was believed to be static from first medical contact to reperfusion therapy. 1,2 However, Fiol Sala and colleagues 4 proposed that the de Winter ECG pat-tern was only a transient phenomenon. Several studies have reported that the de Winter ECG pattern and ST-segment elevation in AMI can evolve jointly.…”

Section: Discussionmentioning

confidence: 99%

The de Winter Electrocardiogram Pattern Evolving From Hyperacute T Waves

Cao

Liu

2021

JAMA Intern Med

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A man in his 40s with a long-term smoking history was referred to the emergency department with persistent chest pain accompanied by sweating and nausea, which had been present for a half-hour. On admission, the patient's vital signs were as follows: blood pressure of 116/74 mm Hg, a regular pulse of 86 beats/min, and a respiratory rate of 19 breaths/min. Cardiopulmonary examination showed no remarkable findings. The initial troponin I level was less than 0.03 ng/mL (normal range, <0.03 ng/mL; to convert to μg/L, multiply by 1.0). An initial 12-lead electrocardiogram (ECG) was performed immediately on admission (Figure , A). Approximately 1 hour later, a preoperative ECG was performed (Figure , B).Questions: What are the notable findings of the ECGs? What can we accomplish with appropriate treatments?

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The “De Winter Pattern” Can Progress to ST-segment Elevation Acute Coronary Syndrome

Cited by 12 publications

References 5 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

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

The de Winter Electrocardiogram Pattern Evolving From Hyperacute T Waves

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