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.
Insights
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.
Background:
The de Winter electrocardiogram (ECG) pattern and Wellens ECG pattern are rare but critical ECG findings, often considered high-risk equivalents of ST-segment elevation myocardial infarction (STEMI) associated with proximal left anterior descending coronary artery (LAD) occlusion, necessitating urgent angiography and reperfusion. Limited literature documents cases where the de Winter ECG pattern transitions into the Wellens pattern following percutaneous coronary intervention (PCI).
Case Summary:
A 73-year-old man with a history of intermittent chest pain over 1 year presented with exacerbation lasting 3 h, leading to hospitalization for acute coronary syndrome (ACS). During chest pain, the ECG displayed the de Winter ECG pattern, prompting immediate emergency coronary angiography. Angiography revealed 90% stenosis at the proximal LAD, subsequently treated with drug-eluting stent placement. The stent expanded well, and LAD forward blood flow was at thrombolysis in myocardial infarction Level 3. Within 24 h post-PCI, the ECG evolved into Type B Wellens pattern, accompanied by the resolution of chest pain. The patient was discharged on the seventh day post-admission.
Discussion:
The de Winter ECG pattern signifies transient severe coronary stenosis during episodes of chest pain. In contrast, the Wellens ECG pattern typically occurs before PCI, with its T-wave changes often appearing during pain-free intervals, indicating spontaneous coronary artery revascularization. Post-PCI, Wellens ECG changes may suggest reperfusion injury. Timely and repeated ECG monitoring in ACS patients is crucial for identifying high-risk ECG patterns and initiating urgent reperfusion therapy. However, a Wellens ECG pattern in pre-cordial leads does not invariably signify LAD occlusion or severe stenosis.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
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...
01:28Electrocardiogram 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...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias