DE WINTER'S SIGN AS ELECTROCARDIOGRAPHIC EQUIVALENT OF STEMI INFARCTION

DOI: https://doi.org/10.5937/halo31-57793
Keywords: electrocardiographic record, STEMI infarction, De Winter's sign

Abstract


Introduction: We present the rarity early recognition and management of De Winter's ECG pattern at the prehospital level.

Case report: A 68-year-old man felt chest pain with propagation in both arms and back, followed by nausea and vomiting. Conscious, pale, cold sweaty, agitated, normofrequency, normotensive. ECG: sinus rhythm 70/min, negative T in D3 and aVF. Reduced r in V2-V4, concomitant ST depression in V3-V5 with high, symmetrical T in V2-V5. A prehospital working diagnosis was De Winter T/ST pattern. After placement of 2 intravenous cannulas, prescribed drug therapy, with monitoring of vital functions and an announcement of arrival, he was transported directly to the catheterization room. The diagnosis was confirmed by an interventional cardiologist and a stent was implanted.

Conclusion: Failure to recognize De Winter's sign as a STEMI equivalent can lead to a delay in activation of the STEMI network and sometimes be fatal to the patient.

References

1. Ivanov I, Stojšić Milosavljević A, Ivanović V, Trajković M, Vulin A, Čanković M. Ekvivalent infarkta miokarda sa elevacijom ST segmenta - elektrokardiogram De Vinterovog T-talasa. Medicinski pregled. 2017; 71(7-8): 265-9. doi: 10.2298/MPNS1808265I
2. Vilela EM, Braga JP. The de Winter ECG Pattern. [Updated 2024 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557573/
3. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al, ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-826. doi: 10.1093/eurheartj/ehad191.
4. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA; Interventional Cardiology Group of the Academic Medical Center. A new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359(19):2071-2073. doi:10.1056/NEJMc0804737.
5. Wang S, Shen L. de Winter syndrome or inferior STEMI?. BMC Cardiovasc Disord. 2021; 21: 614. doi:10.1186/s12872-021-02441-4.
6. Wang H, Dai XC, Zhao YT, Cheng XH. Evolutionary de Winter pattern: from de Winter ECG to STEMI-A case report. BMC Cardiovasc Disord. 2020;20(1):324. doi:10.1186/s12872-020-01611-0.
7. Writing Committee Members, Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie MT, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2022;79(15):1547. doi: 10.1016/j.jacc.2022.03.330.
Published
2025/04/28
Issue
Vol. 31 No. 1 (2025): Naučni časopis urgentne medicine Halo 194
Section
Case report
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