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Aslanger's and de Winter's patterns associated with acute left coronary artery disease: A case report of two patients

Mei Liu1, Lingdi Liang2, Tiantian Zhang2

  • 1Liuzhou People's Hospital, PR China; The First Affiliated Hospital of Guangxi Medical University, PR China.

Journal of Electrocardiology
|April 17, 2026
PubMed

Insights

Atypical electrocardiogram (ECG) patterns like Aslanger's and de Winter's can indicate acute coronary occlusion (ACO). These patterns may signal left coronary artery issues, not just right coronary artery blockages, necessitating prompt diagnosis.

Area of Science:

  • Cardiology
  • Medical Diagnostics

Background:

  • Current acute coronary syndrome (ACS) classification (unstable angina, STEMI, NSTEMI) may miss acute coronary occlusion (ACO) with atypical ECG findings.
  • STEMI-equivalent ECG patterns are increasingly recognized as critical indicators of ACO.
  • Aslanger's pattern typically suggests RCA-related inferior MI, and de Winter's pattern suggests LAD occlusion.

Purpose of the Study:

  • To report two cases of ACS with co-occurring Aslanger's and de Winter's ECG patterns.
  • To investigate the coronary artery origins of these combined atypical ECG manifestations.
  • To highlight the clinical significance of recognizing these patterns for timely reperfusion therapy.

Main Methods:

  • Case report of two patients presenting with ACS.
  • Analysis of admission electrocardiograms (ECGs) for Aslanger's and de Winter's patterns.
  • Coronary angiography to determine the site of acute coronary lesions.

Main Results:

  • Both patients presented with combined Aslanger's and de Winter's ECG patterns.
  • Coronary angiography revealed acute lesions in the left coronary artery system in both cases.
  • Aslanger's pattern was not specific to right coronary artery (RCA) lesions.

Conclusions:

  • The Aslanger's pattern can occur with left coronary artery occlusions, not exclusively RCA lesions.
  • The co-occurrence of Aslanger's and de Winter's patterns warrants increased suspicion for acute left coronary artery lesions.
  • Early identification of these combined ECG patterns is crucial for timely reperfusion and improved patient outcomes.

Keywords:
Acute coronary syndromeAslanger patternLeft coronary artery diseaseSTEMI equivalentde Winter pattern

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