Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2020

Open Access 01-12-2020 | Angiography | Case report

A middle-aged male patient with de Winter syndrome: a case report

Authors: Bo Lu, Deyu Fu, Xunjie Zhou, Mingtai Gui, Lei Yao, Jianhua Li

Published in: BMC Cardiovascular Disorders | Issue 1/2020

Login to get access

Abstract

Background

De Winter syndrome accounts for approximately 2% of all patients with acute anterior myocardial infarction admitted to the emergency department, and is characterized by severe stenosis of the left anterior descending coronary artery (LAD). The ECG changes are not recognized by ECG software, and poor understanding of the syndrome among physicians may lead to misdiagnosis, delayed reperfusion, and mortality.

Case presentation

A 51-year-old male patient presented with a newly developed ECG pattern suggestive of de Winter Syndrome. Coronary angiography revealed anterior myocardial infarction. Based on the ECG and clinical manifestations, the patient was diagnosed with de Winter syndrome and underwent timely percutaneous coronary intervention to revascularize the left anterior descending artery (LAD). The patient showed good outcomes and no complications at 4 months after the operation.

Conclusions

This case highlights the importance of being aware of the possibility of de Winter syndrome in patients with symptoms of myocardial infarction but atypical ECG in order to conduct early revascularization and treatments.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kawecki D, Gierlotka M, Morawiec B, Hawranek M, Tajstra M, Skrzypek M, et al. Direct admission versus Interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2017;10:438–47.CrossRef Kawecki D, Gierlotka M, Morawiec B, Hawranek M, Tajstra M, Skrzypek M, et al. Direct admission versus Interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2017;10:438–47.CrossRef
2.
go back to reference de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. Interventional cardiology Group of the Academic Medical C. a new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359:2071–3.CrossRef de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. Interventional cardiology Group of the Academic Medical C. a new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359:2071–3.CrossRef
3.
go back to reference Verouden NJ, Koch KT, Peters RJ, Henriques JP, Baan J, van der Schaaf RJ, et al. Persistent precordial “hyperacute” T-waves signify proximal left anterior descending artery occlusion. Heart. 2009;95:1701–6.CrossRef Verouden NJ, Koch KT, Peters RJ, Henriques JP, Baan J, van der Schaaf RJ, et al. Persistent precordial “hyperacute” T-waves signify proximal left anterior descending artery occlusion. Heart. 2009;95:1701–6.CrossRef
4.
go back to reference Goebel M, Bledsoe J, Orford JL, Mattu A, Brady WJ. A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr. Am J Emerg Med. 2014;32:287 e5–8.CrossRef Goebel M, Bledsoe J, Orford JL, Mattu A, Brady WJ. A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr. Am J Emerg Med. 2014;32:287 e5–8.CrossRef
5.
go back to reference Rokos IC, French WJ, Mattu A, Nichol G, Farkouh ME, Reiffel J, et al. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J. 2010;160:995–1003 e1-8.CrossRef Rokos IC, French WJ, Mattu A, Nichol G, Farkouh ME, Reiffel J, et al. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J. 2010;160:995–1003 e1-8.CrossRef
6.
go back to reference Fiol Sala M, Bayes de Luna A, Carrillo Lopez A, Garcia-Niebla J. The “De Winter pattern” can Progress to ST-segment elevation acute coronary syndrome. Rev Esp Cardiol (Engl Ed). 2015;68:1042–3.CrossRef Fiol Sala M, Bayes de Luna A, Carrillo Lopez A, Garcia-Niebla J. The “De Winter pattern” can Progress to ST-segment elevation acute coronary syndrome. Rev Esp Cardiol (Engl Ed). 2015;68:1042–3.CrossRef
7.
go back to reference Zhang ZQ, Ding JW, Luo CY, Wang XA. De Winter syndrome with occlusion of the proximal segment of the LAD coronary artery. Int J Clin Exp Med. 2018;11:13929–32. Zhang ZQ, Ding JW, Luo CY, Wang XA. De Winter syndrome with occlusion of the proximal segment of the LAD coronary artery. Int J Clin Exp Med. 2018;11:13929–32.
8.
go back to reference Carr MJ, O'Shea JT, Hinfey PB. Identification of the STEMI-equivalent de Winter electrocardiogram pattern after ventricular fibrillation cardiac arrest: a case report. J Emerg Med. 2016;50:875–80.CrossRef Carr MJ, O'Shea JT, Hinfey PB. Identification of the STEMI-equivalent de Winter electrocardiogram pattern after ventricular fibrillation cardiac arrest: a case report. J Emerg Med. 2016;50:875–80.CrossRef
9.
go back to reference Martinez-Losas P, Fernandez-Jimenez R. de Winter syndrome. CMAJ. 2016;188:528.CrossRef Martinez-Losas P, Fernandez-Jimenez R. de Winter syndrome. CMAJ. 2016;188:528.CrossRef
10.
go back to reference Goktas MU, Sogut O, Yigit M, Kaplan O. A novel electrocardiographic sign of an ST-segment elevation myocardial infarction-equivalent: De Winter syndrome. Cardiol Res. 2017;8:165–8.CrossRef Goktas MU, Sogut O, Yigit M, Kaplan O. A novel electrocardiographic sign of an ST-segment elevation myocardial infarction-equivalent: De Winter syndrome. Cardiol Res. 2017;8:165–8.CrossRef
11.
go back to reference Section of Interventional Cardiology of Chinese Society of Cardiology of Chinese Medical Association, Specialty Committee on Prevention and Treatment of Thrombosis of Chinese College of Cardiovascular Physicians, Editorial Board of Chinese Journal of Cardiology. The Chinese guidelines for percutaneous coronary intervention (2016). Chin J Cardiol. 2016;44:382–400. Section of Interventional Cardiology of Chinese Society of Cardiology of Chinese Medical Association, Specialty Committee on Prevention and Treatment of Thrombosis of Chinese College of Cardiovascular Physicians, Editorial Board of Chinese Journal of Cardiology. The Chinese guidelines for percutaneous coronary intervention (2016). Chin J Cardiol. 2016;44:382–400.
Metadata
Title
A middle-aged male patient with de Winter syndrome: a case report
Authors
Bo Lu
Deyu Fu
Xunjie Zhou
Mingtai Gui
Lei Yao
Jianhua Li
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2020
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-020-01619-6

Other articles of this Issue 1/2020

BMC Cardiovascular Disorders 1/2020 Go to the issue