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. 2020 Nov 26;4(6):1-5.
doi: 10.1093/ehjcr/ytaa402. eCollection 2020 Dec.

The de Winter's pattern revisited: a case series

Thadathilankal-Jess John  1 , Alfonso Pecoraro  1 , Hellmuth Weich  1 , Lloyd Joubert  1 , Bradley Griffiths  1 , Philip Herbst  1
Affiliations

The de Winter's pattern revisited: a case series

Thadathilankal-Jess John et al. Eur Heart J Case Rep. .

Abstract

Background: The de Winter's electrocardiogram (ECG) pattern signifying proximal left anterior descending (LAD) artery occlusion was first described in 2008. The ECG changes were thought to be static and mechanisms for this were suggested. In addition, the optimal management of these patients was reported to be via a primary percutaneous coronary intervention (PCI) strategy.

Case summary: Case 1: A 48-year-old gentleman presented with a 2-h history of ischaemic chest pain with initial de Winter's pattern on ECG. This progressed to anterior ST-elevation myocardial infarction (STEMI) complicated by ventricular fibrillation. Emergency angiography revealed a mid-vessel LAD occlusion which was successfully reperfused. Case 2: A 34-year-old female presented with a 2-h history of ischaemic chest pain with initial ECG showing a de Winter's pattern. Due to concerns of performing PCI timeously, a pharmacoinvasive strategy of reperfusion was adopted with resolution of the de Winter's pattern. Urgent angiography revealed a proximal LAD lesion which was successfully stented.

Discussion: The two cases highlight that the de Winter's pattern may in fact not be static, but rather lie along the continuum of ischaemia and may evolve into STEMI. In addition, we provide further evidence that if primary PCI cannot be offered in a timeous manner, thrombolytic therapy may be considered in such patients. The de Winter's pattern remains a high-risk ECG pattern that requires early recognition and intervention.

Keywords: Case series; De Winter’s ECG; High-risk ECG; LAD occlusion; Pharmacoinvasive strategy; STEMI.

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Figures

Figure 1
Figure 1
(A) Standard 12-lead electrocardiogram. Praecordial leads demonstrate the de Winter's pattern. (B) Progression to anterior ST-elevation myocardial infarction.
Figure 2
Figure 2
(A) Initial electrocardiogram demonstrating de Winter’s pattern. (B) Resolution of the de Winter’s pattern after thrombolytic therapy.
None
See this image and copyright information in PMC

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