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Total Occlusion of the Left Descending and circumflex Coronary Artery without ST Elevation: the De Winter

A Kalkan1, B Cekmen1, B Bas1

  • 1Okmeydani Training and Research Hospital, Department of Emergency Medicine, İstanbul, Turkey.

Acute Medicine
|October 6, 2020
PubMed

Insights

De Winter syndrome, a rare form of myocardial infarction (MI), presents with distinct ECG changes indicating left anterior descending artery occlusion. Early recognition is crucial for managing this critical cardiac event.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Electrocardiography

Background:

  • De Winter syndrome is an uncommon presentation of acute myocardial infarction (MI), accounting for 2% of cases.
  • It is characterized by specific electrocardiogram (ECG) findings, differing from classic ST-elevation MI (STEMI).

Observation:

  • The case involves a 71-year-old patient presenting with chest pain.
  • ECG revealed findings consistent with De Winter syndrome: ST depression in precordial leads and prominent J waves.

Findings:

  • De Winter syndrome signifies critical stenosis or occlusion of the left anterior descending (LAD) coronary artery.
  • Coronary angiography in this patient confirmed occlusions in both the LAD and circumflex (CX) arteries.

Implications:

  • Prompt identification of De Winter syndrome is vital due to its association with significant morbidity and mortality.
  • This case highlights the importance of recognizing atypical ECG presentations for timely intervention in acute coronary syndromes.

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