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Poor efficacy of intravenous thrombolysis in de Winter pattern: A case report
Hao Xiao1, Zhao Mei, Zhang Feifei
1Hebei General Hospital, Shijiazhuang City, Hebei Province, China.
Insights
De Winter syndrome, a critical indicator of severe coronary artery disease, requires prompt recognition and intervention. Percutaneous coronary intervention (PCI) offers a successful treatment strategy for these patients, improving outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) identifies most acute coronary syndrome (ACS) patients.
- A significant 30% of ACS patients with coronary artery lesions are missed by ECG, leading to treatment delays.
Observation:
- De Winter syndrome presents unique ECG findings that are often overlooked by clinicians.
- This case highlights a de Winter syndrome presentation with a suboptimal response to thrombolysis.
Findings:
- Prompt diagnosis of de Winter syndrome enabled immediate percutaneous coronary intervention (PCI).
- The patient experienced a positive recovery following PCI, demonstrating its efficacy.
Implications:
- De Winter syndrome signifies severe coronary artery disease necessitating rapid reperfusion.
- Primary PCI is the preferred strategy for eligible patients within 2 hours.
- Thrombolysis efficacy in non-PCI settings requires further investigation.
Introduction:
Majority of patients with acute coronary syndrome can be quickly identified by electrocardiogram, but there are still 30% of patients with acute coronary artery lesions that cannot be recognized by electrocardiogram in time, resulting in delayed treatment.
Patient Concerns:
Due to its special manifestations, de Winter syndrome is easily ignored by clinicians.
Diagnosis:
In this article we report a case of de Winter syndrome with poor thrombolytic effect to explore the optimal emergency management strategy for this patient.
Interventions:
The patient underwent remedial percutaneous coronary intervention (PCI) immediately after diagnosis.
Outcomes:
Patients recover well after PCI.
Conclusion:
de Winter syndrome is a strong indication of severe coronary artery disease, requiring rapid identification and opening of coronary vessels to restore blood flow. For patients admitted to hospitals with PCI capacity or transferred primary PCI <2 hours, primary PCI should be performed as soon as possible. Thrombolysis can still be considered for patients first diagnosed in non-PCI institutions with transport time >2 hours, but its efficacy remains to be discussed and further verified.
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