CASE REPORT article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1574829
The dynamic evolution of the de Winter ECG pattern that is easily overlooked and lifethreatening: A case report and literature review
Provisionally accepted
- Hainan General Hospital, Haikou, China
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Background Rapid diagnosis of acute coronary syndrome (ACS) patients is crucial for saving their lives. The de Winter electrocardiogram (ECG) pattern is a rare ECG pattern; it is treated the same as ST-segment elevation myocardial infarction (STEMI) and acute thrombotic occlusion of the coronary artery. The de Winter ECG pattern has been reported before, but its dynamic evolution and characteristics have not been summarized. Methods We reported two male patients who presented with de Winter ECG pattern at rest, and neither patient had a family history of hypertension, diabetes, nor coronary heart disease. A literature review was included to examine reported coronary angiography findings in patients with the de Winter pattern. The review focused on the dynamic evolution of the ECG and the accuracy of this pattern in diagnosing acute coronary artery occlusion (culprit's vessel). The review also highlighted the danger of de Winter ECG pattern and the importance of emergency treatment. Results Eighteen patients, including two of our patients, presented with the de Winter ECG pattern. ECG examination showed an upward-sloping ST-segment depression with tall symmetrical T waves in the chest leads, and multiple follow-up ECGs revealed dynamic ST-segment evolution. Emergency coronary angiography showed occlusion of the LAD, left main artery (LMA), right coronary artery (RCA), first diagonal branch (D1), and left circumflex (LCX) artery as well as multiple vascular lesions. Most cases support subtotal stenosis or complete occlusion of the anterior descending artery. Timely identification of the de Winter ECG patterns and prompt transfer to the catheterization laboratory for emergency revascularization can save the patient's life and improve prognosis. Conclusion These two cases and the literature review indicated that the de Winter ECG pattern is dynamically evolving. Its ECG pattern evolution is variable, progressing to STEMI, NSTEMI, Wellens, or even a normal. For chest pain patients, a de Winter ECG pattern, regardless of the subsequent dynamic evolution of the ECG, indicates the presence of severe coronary artery stenosis. The de Winter ECG pattern may be an early manifestation of ACS and requires urgent coronary angiography to save the patient's life and improve prognosis promptly.
Keywords: Acute Coronary Syndrome, De Winter ECG pattern, Coronary Angiography, Left anterior descending, upsloping ST-segment depression, electrocardiogram
Received: 11 Feb 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Chen, Chen, Zhang, Liao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wang Liao, Hainan General Hospital, Haikou, China
Miao Wang, Hainan General Hospital, Haikou, China
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