De Winter ST-T syndrome: an early sign of ST segment elevation myocardial infarction

Abstract

A ´ST-elevation myocardial infarction (STEMI) equivalent´ electrocardiogram (ECG) pattern reflects an acute thrombotic occlusion of a large epicardial coronary artery without ST-segment elevation. In recent studies, one of these STEMI equivalents, is de-Winter T waves defined by an upsloping ST segment depression (> 1mm) beginning from J-point, and symmetrical, long and significant T waves seen in precordial leads. This syndrome is highly predictive for acute proximal left anterior descending artery (LAD) occlusion. We reported the case of a 45-year-old patient suffering from acute chest pain, presenting in our emergency department with a 'de Winter' ECG pattern which had evolved in few minutes, after cardiac arrest, into an anterior STEMI. Reperfusion therapy was successful. Prompt recognition of this atypical ECG pattern can ensure immediate detection of evolvement to a STEMI and therefore provide appropriate emergent reperfusion therapy either with percutaneous coronary intervention (PCI) or fibrinolysis if the PCI is not available.

Keywords

• de winter´ ecg pattern
• stemi equivalent
• left anterior descending coronary artery