The de winter electrocardiographic pattern

Abstract

We present a clinical case of a patient, without previous cardiac history, admitted to the emergency department with chest pain at low probability for coronary artery disease. The first electrocardiogram showed high-risk changes that were mistakenly interpreted as normal; serial electrocardiograms did not show dynamic changes in STsegment or in the T wave. The patient remained asymptomatic and with hemodynamic stability. Ultrasensitive troponin was positive, and echocardiography reported a structurally healthy heart. Finally, the patient was submitted to diagnostic coronary angiography, evidencing involvement of the proximal anterior descending artery. After reviewing again the initial electrocardiogram, it revealed a high-risk pattern (the de Winter).

De Winter presentations and considerations: a case series

“…Various presentations of chest pain to the emergency ward is always challenging in clinical practice. They can range from being harmless to cardiogenic shock and arrest [ 1 ], and can result from benign conditions such as noncardiogenic causes. The electrocardiogram (ECG) has a critical role in the diagnosis and risk assessment of patients.…”

“…The electrocardiogram (ECG) has a critical role in the diagnosis and risk assessment of patients. Some ECG findings are higher risk and are correlated with dangerous outcomes that need urgent management [ 1 ]. In the lack of ST elevation in ECG, there may be some patterns that require emergent angiography [ 2 ].…”