The De Winter-like electrocardiogram pattern associated with multi-vessel disease.

Area of Science:

• Cardiology
• Electrocardiography
• Interventional Cardiology

Background:

• The de Winter electrocardiogram (ECG) pattern is characterized by specific ST-segment and T-wave abnormalities.
• This pattern has been historically associated with acute occlusion of the Left Anterior Descending (LAD) artery.

Observation:

• A case study involving a patient presenting with chest pain and the de Winter ECG pattern.
• The patient's 12-lead ECG exhibited upsloping ST-segment depression in anterior leads (V2-V6), tall symmetrical T waves in V2-V4, J point elevation in aVR, and ST depression in lateral leads.
• The ECG findings were consistent with the de Winter pattern.

Findings:

• Coronary angiography revealed significant stenosis in the LAD (60-80%) and Right Coronary Artery (RCA) (50-60% ostial, 90% mid-segment).
• The patient had multivessel coronary artery disease, not solely LAD occlusion.
• Percutaneous coronary intervention with drug-eluting stents was successfully performed on the RCA lesions.

Implications:

• The de Winter ECG pattern may indicate multivessel coronary artery disease, extending beyond isolated LAD occlusion.
• This case underscores the importance of comprehensive ECG interpretation in patients with acute coronary syndromes.
• Recognition of this pattern can guide timely diagnostic and therapeutic interventions in complex coronary artery disease scenarios.