Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2019; 7(20): 3296-3302
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3296
De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases
Yang-Yi Lin, Yu-Dan Wen, Guo-Lin Wu, Xiang-Dong Xu
Yang-Yi Lin, Guo-Lin Wu, Xiang-Dong Xu, Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medical and Health Sciences, Shanghai 201800, China
Yu-Dan Wen, Department of Electrocardiology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
Author contributions: Lin YY and Wu GL were the patient’s physicians; Wu GL and Xu XD performed the coronary angiography; Lin YY and Wen YD reviewed the literature and contributed to manuscript drafting; Lin YY, Wen YD, and Xu XD were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiang-Dong Xu, MD, Chief Doctor, Department of Cardiology, Jiading District Central Hospital Affiliated Shanghai University of Medical and Health Sciences, No 1, Chengbei Road, Jiading District, Shanghai 201800, China. xuxiangdong8416@163.com
Telephone: +86-21-67073213 Fax: +86-21-67073325
Received: April 30, 2019
Peer-review started: April 30, 2019
First decision: September 9, 2019
Revised: September 19, 2019
Accepted: September 25, 2019
Article in press: September 25, 2019
Published online: October 26, 2019
Processing time: 179 Days and 12.5 Hours
Abstract
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 ST-segment 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.

Keywords: De Winter syndrome; ST-segment upsloping depression; Dynamic; Case report

Core tip: The de Winter electrocardiography pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain. The classic thinking of the de Winter pattern is that it represents a static situation. Our cases demonstrate that de Winter and ST-segment elevation myocardial infarction represent a dynamic spectrum that may evolve in either direction, i.e., toward coronary vessel occlusion or toward thrombolysis.