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[de Winter syndrome, an easily ignored but life-threatening disease: a case report]

Xiao Yuanyuan1, Fan Zhongguo1, X U Bao2

  • 1Department of Cardiology, Subei People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China.

Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University
|September 8, 2020
PubMed

Insights

De Winter syndrome, a STEMI equivalent, presents unique ECG changes without ST-elevation. Prompt recognition and PCI are crucial for survival in this high-mortality condition.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Electrocardiography

Background:

  • De Winter syndrome is an underrecognized variant of ST-segment elevation myocardial infarction (STEMI).
  • It is characterized by specific electrocardiogram (ECG) findings in precordial leads, often masking as non-ST-elevation myocardial infarction.
  • This syndrome is frequently associated with proximal left anterior descending (LAD) coronary artery occlusion.

Observation:

  • A case report details a 63-year-old male presenting with de Winter syndrome.
  • Initial ECG did not show overt ST-elevation, a key diagnostic challenge.
  • Coronary angiography revealed a total occlusion of the proximal LAD artery.

Findings:

  • The patient's ECG exhibited characteristic de Winter pattern: ST-segment depression with upsloping and tall symmetrical T-waves.
  • Despite initial non-diagnostic ECG for STEMI, the underlying pathology was critical LAD occlusion.
  • Successful treatment involved percutaneous coronary intervention (PCI) with mechanical reperfusion and stenting.

Implications:

  • De Winter syndrome carries a high mortality rate, often due to delayed diagnosis and treatment.
  • Increased clinician awareness of this ECG pattern is vital for timely intervention.
  • Immediate reperfusion therapy, particularly PCI, is the definitive life-saving treatment for de Winter syndrome.

Keywords:
ST-segment elevation myocardial infarctionde Winter syndromeleft anterior descendingpercutaneous coronary intervention

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