A New ECG Sign of Proximal LAD Occlusion

Winter, Robbert J. de; Verouden, Niels; Wellens, Hein J.J.; Wilde, Arthur A.M.

doi:10.1056/nejmc0804737

Cited by 340 publications

(312 citation statements)

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“…The high and symmetrical T waves appear to be a temporary finding and that precedes the ST-segment depression of the pre-cordials [6].…”

Section: Discussionmentioning

confidence: 89%

“…However, some patients develop certain electrocardiographic patterns with no ST elevation, but with severe lesions equivalent to ST elevation myocardial infarction, such as the de Winter pattern [3,4]. This is characterized by ST depression and T wave apical and symmetrical from V1 to V5 leads, associated or not with ST elevation at AVR, denoting total occlusion of the anterior descending artery.…”

Section: Discussionmentioning

confidence: 99%

“…For example, many patients have extensive involvement of the epicardial arteries but, on the ECG, they do not have STEMI (ST-Elevation Myocardial Infarction). Therefore, several patterns of equivalence are currently being described, among them is the De Winter pattern, which should be conducted with the same urgency as an ACS in the emergency room [6].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Total Occlusion of Anterior Descending Artery (AD) without ST-Segment Elevation: DE Winter Pattern

Alcantara¹,

Filho²,

Lino³

et al. 2018

JPP

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Abstract:The recognition of the presence of ST-segment elevation in the context of ACS (acute coronary syndrome) is fundamental for the good outcome of the case. However, some electrocardiographic patterns have been highlighted by the fact that there is no elevation, but they represent a severity similar to ACS with ST elevation. Hence, it is necessary that doctors who do the first service recognize these standards promptly.The electrocardiographic pattern of association between the ST-segment depression and the hyperacute T waves representing myocardial infarction in the anterior wall, localizing more specifically in the anterior descending artery, now known as the De Winter pattern, was first described by Dressler, and then described by Winter six years later. Winter observed that, out of a series of 1,452 cases, 2% of patients with anterior wall infarction had the pattern of ST-segment depression, positive and symmetrical T waves, and occasionally mild ST-segment elevation at AVR derivation. Those patients are admitted to the emergency room with a typical chest pain. However, because the electrocardiographic findings of this syndrome are not known to many health professionals, in many cases the patients do not receive adequate care and have fatal outcome, since mortality is relevant in these cases. Thus, the rapid recognition of this pattern is extremely necessary for the correct and effective intervention.

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“…The high and symmetrical T waves appear to be a temporary finding and that precedes the ST-segment depression of the pre-cordials [6].…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Total Occlusion of Anterior Descending Artery (AD) without ST-Segment Elevation: DE Winter Pattern

Alcantara¹,

Filho²,

Lino³

et al. 2018

JPP

View full text Add to dashboard Cite

show abstract

“…1,2 These ECG patterns, named after Wellens and de Winter, respectively, occasionally replace the classic ECG manifestations of ST-elevation myocardial infarction (STEMI). Initially described in 1982 3 and 2008, 4 respectively, both correspond to proximal severe disease of the left anterior descending artery, with rapid recognition and intervention being required to ensure revascularization.…”

mentioning

confidence: 99%

“…3,4 The differences between the two patterns may reflect the timing of ECG relative to total occlusion of the vessel, spontaneous reperfusion of the vessel, initiation of the ischemic process or reso lution of the ischemic process. Recognizing the two patterns can help physicians to make correct and timely medical decisions, so as to rescue as much myocardium as possible.…”

mentioning

confidence: 99%