Abstract
Introduction: The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as static pattern associated with anterior myocardial infarction. A recent study showed the evolution sequence of this pattern into typical ST-elevation myocardial infarction (STEMI). This case discussed dWP who present as pre-anterior STEMI.
 Case Illustration: A-56-year old Male arrived in the emergency room complained chest pain about 3 hours. The patient also complained of diaphoresis, nausea, and fatigue. The patient has a previous history of hypertension. The vital signs were stable with an unremarkable physical examination. The initial electrocardiogram (ECG) revealed sinus rhythm with j-point depression followed by prominent T wave in precordial leads, slight ST-segment elevation in aVR, and loss of precordial R-wave progression. The initial-troponin-T was 31 pg/mL. Follow-up 1-hour after initial ECG showed typical ST-segment-elevation in V1-V4. The patient undergoing thrombolytic, followed by angiography that showed subtotal occlusion in the proximal left anterior descending (LAD) artery, occlusion in the proximal circumflex artery and stenosis in proximal right coronary artery, echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was discharged after 8-days treated in intensive cardiac care unit.
 Conclusion: dWP has been shown as static and dynamic pattern in some conditions and associated with acute LAD occlusion. In this case, we showed dWP as early anterior STEMI, recognition of this pattern lead to early reperfusion and better myocardial salvage as anterior STEMI has a poor outcome.
Highlights
7KHGH:LQWHUSDWWHUQ G:3 ZDVÀUVWGHVFULEHGE\GH:LQWHU and colleagues in 2008 as a static pattern associated with anterior myocardial infarction
Acute myocardial ischemia caused by coronary artery occlusion causes electrophysiological changes of the cardiac cell that lead to the appearance of a characteristic pattern in surface electrocardiogram (ECG)
The de Winter pattern was first described by de Winter and colleagues in 2008 as a static pattern of ECG that is associated with anterior myocardial infarction associated with left anterior descending (LAD) artery occlusion.[1]
Summary
Acute myocardial ischemia caused by coronary artery occlusion causes electrophysiological changes of the cardiac cell that lead to the appearance of a characteristic pattern in surface electrocardiogram (ECG). The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as a static pattern of ECG that is associated with anterior myocardial infarction associated with left anterior descending (LAD) artery occlusion.[1] The ECG characteristics including upsloping STsegment depression at the J-point in precordial leads followed by a prominent positive symmetrical T wave, other additional characteristics including slight STsegment elevation in aVR and loss of precordial R wave progression. The ECG 1-hour after thrombolytic therapy showed typical ST-segment elevation in the precordial area with marked loss of R wave progression (Figure 2). Follow-up 24 hours troponin-T showed marked elevation (10.000 pg/ mL), echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was stable during hospitalization and discharged after-8 day treated in the intensive cardiac care unit
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
