Evolutionary de Winter pattern: from STEMI to de Winter ECG-a case report
Weijun Huang1, Linlin Mai1, Jianhua Lu1
1Department of Cardiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Shunde, Foshan, China.
Insights
The de Winter electrocardiogram (ECG) pattern can evolve from ST-segment elevation, indicating an evolving coronary thrombus. This dynamic ECG finding suggests proximal left anterior descending artery occlusion and requires prompt medical attention.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- The de Winter electrocardiogram (ECG) pattern is a recognized indicator of proximal left anterior descending (LAD) coronary artery occlusion.
- Early identification of acute coronary syndromes (ACS) is critical for timely intervention and improved patient outcomes.
Observation:
- A 34-year-old male smoker presented with acute chest pain.
- Initial ECG showed ST-segment elevation in leads V2-V4.
- A subsequent ECG, 57 minutes later, revealed the de Winter ECG pattern.
Findings:
- The patient underwent percutaneous coronary intervention (PCI) approximately 8 hours after symptom onset.
- Coronary angiography confirmed a complete occlusion of the proximal LAD artery.
- The case demonstrates the evolution of ST-segment elevation myocardial infarction towards the de Winter ECG pattern.
Implications:
- The de Winter ECG pattern may represent an evolving coronary thrombus rather than a static finding.
- Clinicians should consider the dynamic nature of ECG changes in ACS.
- This case highlights the importance of serial ECG monitoring in patients with chest pain.
Abstract:
The de Winter electrocardiography (ECG) pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain. We report a case of a 34-year-old man with a history of smoking who presented to the local emergency department with a 49 min history of chest pain. The first ECG of the patient indicated that ST-segment elevation was noted in the lead V2-V4; 57 min later, a second ECG revealed a typical de Winter syndrome when the patient was transferred to the emergency chest pain centre of our hospital. A percutaneous coronary intervention (PCI) was performed approximately 8 h later because the patient initially refused the PCI. Acute coronary artery angiography showed that the proximal left anterior descending coronary artery was completely occluded. Our case suggests that ST-segment elevation myocardial infarction may evolve in the direction of de Winter, which reflects a coronary thrombus in formation, so the de Winter ECG pattern should not be considered static.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:24ECG Interpretation of Rhythms
Components of the Electrocardiogram
The primary components of a normal ECG waveform in Normal sinus rhythm(NSR) include the P wave, PR interval, QRS complex, ST segment, T wave, and occasionally a U wave.
ECG waveforms are divided by vertical and horizontal lines at standard intervals.
The horizontal axis measures time and rate, and the vertical axis measures amplitude or voltage....
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
01:16ECG Interpretation of Arrhythmias I: Sinus Arrhythmias
Types of Arrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia: Originating from the sinoatrial (SA) node, sinus bradycardia involves slower impulses, resulting in a heart rate of less than 60 beats per minute (bpm). Causes include sleep, vagal stimulation, beta-blockers, hypothyroidism,...