De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases  

作　　者：Yang-Yi Lin Yu-Dan Wen Guo-Lin Wu Xiang-Dong Xu 

机构地区：[1]Department of Cardiology,Jiading District Central Hospital Affiliated Shanghai University of Medical and Health Sciences,Shanghai 201800,China [2]Department of Electrocardiology,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,Zhejiang Province,China

出　　处：《World Journal of Clinical Cases》2019年第20期3296-3302,共7页世界临床病例杂志

摘　　要：BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min.The first ECG showed only T-wave inversion in III and aVF leads.Another ECG was performed at the 100th minute,showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads;the J point was raised by 0.1 mV at the aVR lead.The patient was referred to our catheterization laboratory.A third ECG showed ST segment elevation by 0.2 mV in the I and aVL leads.The patient underwent emergency coronary angiography,which revealed complete proximal left anterior descending coronary(LAD)occlusion.The second patient presented with a 1-h history of sudden-onset,severe,substernal crushing chest pain.The first ECG showed STsegment elevation(0.1–1.7 mV)in I,aVL,and precordial leads.The patient was referred to the catheterization laboratory.On arrival,his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back.The third ECG showed a typical de Winter pattern.Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic,and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.BACKGROUND The de Winter electrocardiography(ECG) pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain. The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min. The first ECG showed only T-wave inversion in III and aVF leads. Another ECG was performed at the 100 th minute, showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads; the J point was raised by 0.1 mV at the aVR lead. The patient was referred to our catheterization laboratory. A third ECG showed ST segment elevation by0.2 mV in the I and aVL leads. The patient underwent emergency coronary angiography, which revealed complete proximal left anterior descending coronary(LAD) occlusion. The second patient presented with a 1-h history of sudden-onset, severe, substernal crushing chest pain. The first ECG showed STsegment elevation(0.1–1.7 mV) in I, aVL, and precordial leads. The patient was referred to the catheterization laboratory. On arrival, his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back. The third ECG showed a typical de Winter pattern. Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic, and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.

关 键 词：DE WINTER SYNDROME ST-SEGMENT upsloping depression Dynamic Case REPORT 

分 类 号：R54[医药卫生—心血管疾病]