The de Winter electrocardiographic pattern evolves to ST elevation in acute total left main occlusion: A case series

The De Winter-like electrocardiogram pattern associated with multi-vessel disease

BACKGROUND

The de Winter ECG pattern was described by upsloping ST-segment depression in leads V1-V6, tall and symmetrical T waves in precordial leads. The ECG pattern is regarded to be associated with occlusion of the left anterior descending (LAD) artery.

METHODS

One patient with de Winter ECG pattern was included. The 12-lead ECG of patients with chest pain showed upsloping ST-segment depression up to 3 mm at the J point in leads V2-V6; tall symmetrical T waves in leads V2-V4; 1mm J point elevation in lead aVR; ST-segment depression 1mm in I, aVL leads and inverted T waves in the inferior leads. The ECG was showed the de Winter pattern.

RESULTS

The ECG was showed the de Winter pattern. CAG was performed, which showed the normal left main; 60%-80% LAD stenosis; 50%-60% ostial right coronary artery(RCA) stenosis; and 90% stenosis of the vessel at middle segment. Both proximal and middle RCA vascular lesions were dilated and successfully inserted with drug-eluting stents, respectively.

CONCLUSION

Our case the ECG was showed horizontal ST depression with tall T waves in leads V2-V4 (maximal ST depression in lead V4) while only ST depression in leads V5-V6, which may result from multivessel disease.