De Winter Electrocardiogram Pattern Research Articles

De Winter electrocardiogram pattern due to type A aortic dissection: a case report

BackgroundDe Winter electrocardiograph (ECG) pattern is an atypical presentation of acute myocardial infarction (AMI) due to severe stenosis of the left anterior descending (LAD). Complications of acute aortic dissection (AD) in the setting of acute myocardial infarction (AMI) with de Winter sign are relatively rare and physicians may easily miss the diagnosis of AD. We report a case of patient with acute chest pain and de Winter ECG pattern due to AD involving the left main coronary artery (LM), LAD and left circumflex artery (LCX).Case presentationA 57-year-old male patient was initially diagnosed with AMI and then the diagnosis of acute AD was supported by transthoracic echocardiograph (TTE). After two stents were implanted respectively into the proximal LM-LAD and LM-LCX, he recovered from cardiogenic shock. Two months later, the patient underwent the surgery of ascending aorta replacement. After the surgery, there was no obvious chest discomfort during follow-up.ConclusionsWhen an ECG shows a “de Winter pattern”, we should also consider the possibility of AD which result in LAD occlusion. TTE is a useful tool in screening for AD. Further research is needed to prove that percutaneous coronary intervention (PCI) may be a useful treatment strategy in the case of AD leading to severe LAD occlusion and unstable hemodynamics when there’s no condition to perform aortic replacement surgery immediately.

Analysis of clinical features and coronary angiography in 10 patients with de winter syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Guohua Ni Objective To investigate the clinical characteristics and electrocardiogram (ECG) changes of patients with de winter syndrome, so as to enhancing the awareness of de Winter ECG pattern and conducting early emergency interventional therapy for the patients. Methods The clinical data of 10 cases of patients with de winter syndrome admitted to a Medical University Hospital from January 2015 to May 2019 were retrospectively analyzed, to summarize the clinical characteristics, de Winter ECG pattern, timing of emergency interventional therapy, prognosis and other factors. Results Among the 10 patients with de winter syndrome, 9 males and 1 female, 3 cases of acute extensive anterior wall myocardial infarction (MI), 3 cases of non-ST -segment elevation MI (NSTEMI), 2 cases of acute anterior wall MI, and 2 cases of acute anterior septal MI. All the cases were in line with de winter ECG pattern, and they all had dynamic evolution characteristics. Of these, 7 patients developed ST-segment elevation MI (STEMI) and 3 patients developed NSTEMI. All cases were performed coronary angiography (CAG) and 9 patients were performed percutaneous coronary intervention(PCI). CAG showed that there were 6 cases of multi-vessel coronary disease, 4 cases of proximal occlusion of left anterior descending artery, 2 cases of subtotal occlusion, 1 case of 95% stenosis in proximal middle segment of stent. There was 1 case of middle occlusion of anterior descending branch and 1 case of subtotal occlusion, all the above 9 cases were performed PCI. One case had 95% stenosis in the middle segment of anterior descending branch, and no interventional therapy was performed due to hematuria. Conclusion de winter ECG pattern should be regarded as an STEMI equivalent, prompt recognition of the de winter ECG pattern and a timely diagnosis is of the utmost importance, in order to perform early emergency medical and interventional therapy. Clinical Implications * My study will enable cardiovascular clinicians to enhancing the awareness of de Winter ECG pattern and conducting early emergency interventional therapy for the patients, so as to improve the outcome and prognosis of the de winter syndrome. Abstract Figure.

Cognition and progress of de Winter electrocardiogram pattern.

The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.

Clinical characteristics of patients with the de Winter electrocardiogram pattern.

To explore the electrocardiogram manifestations and clinical characteristics of patients with the de Winter electrocardiogram pattern. This retrospective study was performed on acute coronary syndrome (ACS), patients with culprit lesion in left anterior descending branch (LAD), who admitted to Yongchuan Hospital of Chongqing Medical University from August 2017 to October 2018. Patients were categorized into those with or without the de Winter electrocardiogram pattern. The characteristics of de Winter electrocardiogram were analyzed by the clinical data of the patients. Among 230 patients with left anterior descending branch lesion, 14 (6%) had the de Winter electrocardiogram pattern. Compared with the control group, patients with de Winter electrocardiogram pattern were younger [(53.86±10.26) years old vs (67.20± 11.60) years old P<0.01], at higher LDL-C level [3.54(2.88, 4.20) mmol/L vs 2.61(2.48, 2.73) mmol/L, P=0.01], in lower classification degree of cardiac function [Killip I grade 12 cases (85.71%) vs 95 cases (43.98%), P=0.04], and in shorter time between onset and the first electrocardiogram [171.77(47.56, 295.97) min vs 501.92(405.12, 598.72) min, P=0.01]. Coronary angiography results indicated anterior descending or diagonal branch lesions. The de Winter electrocardiogram pattern syndrome in patients with acute chest pain mostly indicates that the left anterior descending or the diagonal branch is subtotal or completely occluded, which is a special ST-segment elevation myocardial infarction equivalent and should attract the clinicians' extensive attention.

The de Winter electrocardiogram pattern in a 52-year-old-male: a case report

Background The 12-lead electrocardiogram (ECG) remains the primary test for diagnosis of acute myocardial infarction (MI) secondary to acute coronary occlusion or near occlusion, with insufficient collateral circulation. Decisions regarding urgent reperfusion are based on whether or not there’s new ST-segment elevation. The de Winter ECG pattern is a distinct ECG pattern without any ST-segment elevation, it may be missed by anyone unfamiliar with it.Case summary We present a case whose chief complaint was severe central chest pain, the patient was diagnosed with acute MI secondary to a culprit lesion in the left anterior descending artery, despite the ECG not meeting standard STEMI criteria. After the ECG’s significance was recognized by paramedics, the patient received immediate percutaneous coronary intervention with stenting and was discharged home after a brief hospital admission.Discussion In some cases, acute MI presents with ECG features that do not meet the standard criteria for STEMI diagnosis. The de Winter ECG pattern is one such example. This pattern should be immediately recognizable to those responsible for the activation of the catheterization laboratory, physicians, and paramedics included.

Thrombolytic therapy in a patient with chest pain with de Winter ECG pattern occurred after ST-segment elevation: A case report

The de Winter electrocardiogram (ECG) pattern may signify proximal left anterior descending artery (LAD) occlusion and was suggested to be managed as ST-segment elevation myocardial infarction (STEMI) equivalent for urgent angiography and reperfusion therapy. However, cardiac catheter laboratory is not readily or timely available in every hospital. When timely percutaneous coronary intervention (PCI) is not available, thrombolytic therapy can be considered in patients with ongoing ischemia symptoms. Here, we present a case of a successful thrombolytic therapy with de Winter ECG pattern occurred after ST-segment elevation in a scenario which the catheter laboratory was unavailable.

The de winter electrocardiogram pattern is a transient electrocardiographic phenomenon that presents at the early stage of ST-segment elevation myocardial infarction.

The de Winter electrocardiogram (EKG) pattern is a novel sign that indicates left anterior descending coronary artery (LAD) occlusion in patients with chest pain. This study aimed to assess the prevalence and clinical characteristics of patients with this pattern. The de Winter EKG pattern is an special anterior ST-segment elevation myocardial infarction (STEMI) equivalents without obvious ST-segment elevation. This retrospective study included all patients with anterior myocardial infarction admitted between January 2011 and December 2017. Patients were categorized into two groups: those with the de Winter EKG pattern and those with typical STEMI. Of 441 patients, 15 (3.4%) with anterior myocardial infarction had the de Winter EKG pattern. Similar to those with typical STEMI, the majority of patients with the de Winter EKG pattern had ST-segment elevation, pathologic Q wave, and absence of R wave at follow-up. The median time from recognition of this pattern until its evolution was 114 minutes. The ST-segment in leads V3R to V5R and leads V7 to V9 were normal or slightly depressed when a typical de Winter EKG pattern was noted in leads V1 to V6. The culprit lesion was mainly in the proximal LAD or the diagonal branch. Patients with this EKG pattern responded poorly to thrombolytic therapy. We believe that the de Winter EKG pattern may be a sign of ischemia and presents at the early stage of STEMI rather than being an independent pattern. In patients with this pattern, a percutaneous coronary intervention rather than follow-up and thrombolytic strategy should be performed.

Subtle de Winter in a 40 Years Old Male with No Chest Pain

BACKGROUND: It is well known that the Electrocardiogram (ECG) is the first and most important test to diagnose patients with acute coronary syndrome (ACS). ST elevations on ECG in a patient presenting with chest pain is defined as ST elevation myocardial infarction (STEMI) and is confirmed by cardiac catheterization. Various STEMI equivalents have been reported in the literature. Most STEMI equivalents are often missed or not recognized by physicians. So, giving attention to these presentations are very important for physicians and cardiologist. The de Winter ECG pattern is one of the rare STEMI equivalents presentations which deserves emergent reperfusion therapy. CASE REPORT: This case report describes a very subtle ECG pattern which found to have critical occlusion of the proximal left anterior descending (LAD) artery in a previously healthy 40-year-old patient who presented to the Emergency Department (ED) with no chest pain. The patient did not have any risk factors for ACS and was not taking any medication. The initial ECG showed mild ST depression, which was changed to biphasic T wave later on. Recognizing this specific ECG pattern is important to direct patients toward appropriate management early and prevent delay in diagnoses.

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

BackgroundPatients with chest pain who have ST elevations on electrocardiogram (ECG) are at high risk for ST-elevation myocardial infarction (STEMI). Recent literature has reported various STEMI equivalents, which may be equally threatening. One STEMI equivalent, previously named the de Winter pattern, describes ECG changes where there are ST-segment depressions in the precordial leads in association with tall, symmetrical, hyperacute T-waves. These changes have been connected with proximal left anterior descending coronary artery occlusion. Case ReportWe have identified a case of the de Winter ECG pattern immediately after ventricular fibrillation cardiac arrest. A 33-year-old man presented with waxing and waning severe substernal chest pain. The patient was on no prior medications, and had no risk factors for acute coronary syndrome. The initial ECG showed ST depression, which was followed by normalization in a repeat ECG only minutes later. The patient then developed ventricular fibrillation cardiac arrest. After defibrillation, return of spontaneous circulation was achieved and subsequent ECGs demonstrated the de Winter ECG pattern. Why Should an Emergency Physician Be Aware of This?The characteristic ECG changes within the de Winter ECG pattern may be missed or misdiagnosed as nonspecific, reversible ischemia. This can significantly lengthen the transportation to a center equipped with a percutaneous coronary intervention laboratory, and thus the start of reperfusion therapy. It is imperative that all practitioners learn to identify this novel ECG pattern as a STEMI equivalent to ensure appropriate intervention in the cardiac catheterization laboratory.