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Case Reports
. 2020 Jul 18;20(1):342.
doi: 10.1186/s12872-020-01619-6.

A middle-aged male patient with de Winter syndrome: a case report

Affiliations
Case Reports

A middle-aged male patient with de Winter syndrome: a case report

Bo Lu et al. BMC Cardiovasc Disord. .

Abstract

Background: De Winter syndrome accounts for approximately 2% of all patients with acute anterior myocardial infarction admitted to the emergency department, and is characterized by severe stenosis of the left anterior descending coronary artery (LAD). The ECG changes are not recognized by ECG software, and poor understanding of the syndrome among physicians may lead to misdiagnosis, delayed reperfusion, and mortality.

Case presentation: A 51-year-old male patient presented with a newly developed ECG pattern suggestive of de Winter Syndrome. Coronary angiography revealed anterior myocardial infarction. Based on the ECG and clinical manifestations, the patient was diagnosed with de Winter syndrome and underwent timely percutaneous coronary intervention to revascularize the left anterior descending artery (LAD). The patient showed good outcomes and no complications at 4 months after the operation.

Conclusions: This case highlights the importance of being aware of the possibility of de Winter syndrome in patients with symptoms of myocardial infarction but atypical ECG in order to conduct early revascularization and treatments.

Keywords: Electrocardiogram; Myocardial infarction; Revascularization; ST-elevated myocardial infarction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Emergency ECG showing de Winter ECG pattern
Fig. 2
Fig. 2
Angiography results before (a) and 8 days after (b) stent implantation
Fig. 3
Fig. 3
ECG immediately after stent implantation
Fig. 4
Fig. 4
ECG 3 days after stent implantation

References

    1. Kawecki D, Gierlotka M, Morawiec B, Hawranek M, Tajstra M, Skrzypek M, et al. Direct admission versus Interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2017;10:438–447. doi: 10.1016/j.jcin.2016.11.028. - DOI - PubMed
    1. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. Interventional cardiology Group of the Academic Medical C. a new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359:2071–2073. doi: 10.1056/NEJMc0804737. - DOI - PubMed
    1. Verouden NJ, Koch KT, Peters RJ, Henriques JP, Baan J, van der Schaaf RJ, et al. Persistent precordial “hyperacute” T-waves signify proximal left anterior descending artery occlusion. Heart. 2009;95:1701–1706. doi: 10.1136/hrt.2009.174557. - DOI - PubMed
    1. Goebel M, Bledsoe J, Orford JL, Mattu A, Brady WJ. A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr. Am J Emerg Med. 2014;32:287 e5–287 e8. doi: 10.1016/j.ajem.2013.09.037. - DOI - PubMed
    1. Rokos IC, French WJ, Mattu A, Nichol G, Farkouh ME, Reiffel J, et al. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J. 2010;160:995–1003. doi: 10.1016/j.ahj.2010.08.011. - DOI - PubMed

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