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De Winter ECG Pattern: A Critical Sign of Occlusion Myocardial Infarction
Introduction
The De Winter ECG pattern is an important but less well-known electrocardiographic sign that can indicate an imminent anterior myocardial infarction (MI). This pattern is considered an ST-elevation myocardial infarction (STEMI) equivalent, meaning it signals a complete occlusion of the left anterior descending (LAD) artery even though classic ST-elevation is absent.
What Does the De Winter ECG Pattern Look Like?
Instead of traditional ST-elevation, the De Winter ECG pattern is characterized by: - Upward-sloping ST depression at the J-point (V1-V6) - Tall, symmetrical T-waves in the precordial leads - Absence of classic ST-elevation - Often associated with initial high troponin levels
Why Is It Important?
- It is often misinterpreted as non-ST elevation myocardial infarction (NSTEMI), which can delay proper treatment.
- It represents an acute and complete occlusion of the LAD artery, a life-threatening condition.
Clinical Significance
Since De Winter’s pattern is a sign of an urgent coronary occlusion, it should be managed just like a STEMI: immediate reperfusion therapy is required (such as PCI or thrombolysis).
What Should Be Done?
- Immediate recognition of the pattern by clinicians.
- Emergency coronary angiography to confirm LAD occlusion.
- Primary percutaneous coronary intervention (PCI) as the preferred treatment.
- If PCI is unavailable, thrombolytic therapy should be considered.
Conclusion
The De Winter ECG pattern is a critical finding that represents a STEMI-equivalent and requires rapid recognition and treatment. Missing this pattern can lead to fatal consequences. If you or someone you know experiences symptoms like chest pain, immediate medical attention and an ECG are essential.
Source recommendations
1. 2024 American College of Cardiology/American Heart Association Guidelines for Management of ST-Elevation Myocardial Infarction
- https://www.ahajournals.org/doi/10.1161/01.cir.0000134791.68010.fa
- https://www.acc.org/Guidelines
- https://www.ahajournals.org/doi/10.1161/cir.0b013e3182742cf6
- https://www.ncbi.nlm.nih.gov/books/NBK532281/
- https://pubmed.ncbi.nlm.nih.gov/23247304/
2. 2023 European Society of Cardiology Guidelines for Acute Coronary Syndromes
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
- https://academic.oup.com/eurheartj/article/44/38/3720/7243210
- https://pubmed.ncbi.nlm.nih.gov/37622654/
- https://journals.lww.com/cd/fulltext/2023/12000/what_is_new_in_the_2023_european_society_of.1.aspx
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
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