de Winter electrocardiogram pattern evolving into Wellens electrocardiogram pattern in post-percutaneous coronary
1Department of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin 300211, China.
European Heart Journal. Case Reports
|July 21, 2025
Summary
The de Winter electrocardiogram (ECG) pattern can evolve into the Wellens ECG pattern after percutaneous coronary intervention (PCI) for left anterior descending (LAD) artery occlusion. This case highlights critical ECG monitoring post-PCI for acute coronary syndrome (ACS).
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Electrocardiography
Background:
- The de Winter and Wellens electrocardiogram (ECG) patterns are critical indicators of proximal left anterior descending (LAD) coronary artery occlusion, often necessitating urgent intervention.
- Limited data exists on the transition of the de Winter ECG pattern to the Wellens ECG pattern following percutaneous coronary intervention (PCI).
Observation:
- A 73-year-old male presented with acute coronary syndrome (ACS) exhibiting the de Winter ECG pattern during chest pain.
- Coronary angiography revealed severe proximal LAD stenosis, treated with PCI.
- Post-PCI, the patient's ECG evolved to a Wellens pattern (Type B) within 24 hours, coinciding with symptom resolution.
Findings:
- The de Winter ECG pattern indicates transient severe coronary stenosis.
- The Wellens ECG pattern, typically seen pre-PCI, may indicate reperfusion injury post-PCI.
- This case demonstrates a de Winter to Wellens ECG pattern transition after successful PCI for LAD occlusion.
Implications:
- Continuous ECG monitoring is vital for identifying high-risk patterns in ACS patients.
- The evolution of ECG patterns post-PCI can provide insights into myocardial reperfusion and potential injury.
- Understanding these ECG transitions aids in timely diagnosis and management of acute myocardial infarction.
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