De Winter syndrome
| de Winter syndrome | |
|---|---|
| Other names | de Winter pattern,[1] de Winter T waves,[2] de Winter's T-waves |
 | |
| ECG showing De Winter syndrome with upsloping ST-segment depression and tall symmetrical T-waves in lead V1 to V6 | |
| Specialty | Cardiology |
| Symptoms | Chest pain, shortness of breath[1] |
| Usual onset | Sudden[1] |
| Causes | Blockage of the left anterior descending artery (LAD)[1] |
| Diagnostic method | ECG[1] |
| Differential diagnosis | High potassium, tachycardia, benign early repolarization[1][3] |
| Treatment | As per ST elevation MI (STEMI)[1][4] |
| Frequency | 2.5% of anterior MIs[1] |
| Deaths | High[4] |
de Winter syndrome is an electrocardiogram (ECG) pattern which often represents sudden near blockage of the left anterior descending artery (LAD).[1][5] Symptoms include chest pain, shortness of breath, and sweating.[1]
While typically due to blockage of the LAD, other arteries of the heart may be involved.[1] Risk factors are similar to other types of ischemic heart disease.[1] The underlying mechanism is unclear; though may involve subendocardial ischemia or collateral circulation.[1]
Diagnosis is based on an ECG showing ST-segment depression at the J-point of 1 to 3 mm in leads V1 to V6, with tall and symmetrical T waves.[1] The ST-segment is upsloping and there is also often ST-segment elevation of 0.5 to 2 mm in lead aVR.[1][2] The QRS complex is either normal or slightly wide.[1]
Treatment is as per an ST elevation MI (STEMI), with primary percutaneous coronary intervention (PCI) being preferred.[1][4] De Winter syndrome is uncommon, representing about 2 to 3% of people with anterior MIs.[1] Males are more commonly affected than females.[1] It was first described in 2008 by Robbert J. de Winter.[1][2]
References
[edit]- ^ a b c d e f g h i j k l m n o p q r s t Vilela, EM; Braga, JP (January 2022). "DeWinter Pattern". StatPearls. PMID 32491505.
- ^ a b c Buttner, Robert; Burns, Ed; Burns, Robert Buttner and Ed (11 October 2021). "De Winter T Wave". Life in the Fast Lane • LITFL. Archived from the original on 31 October 2021. Retrieved 28 July 2022.
- ^ "De Winter's T waves - WikEM". wikem.org. Archived from the original on 2021-05-07. Retrieved 2022-07-28.
- ^ a b c Raja, JM; Nanda, A; Pour-Ghaz, I; Khouzam, RN (September 2019). "Is early invasive management as ST elevation myocardial infarction warranted in de Winter's sign?-a "peak" into the widow-maker". Annals of Translational Medicine. 7 (17): 412. doi:10.21037/atm.2019.07.19. PMC 6787391. PMID 31660311.
- ^ Tzimas, Georgios; Antiochos, Panagiotis; Monney, Pierre; Eeckhout, Eric; Meier, David; Fournier, Stephane; Harbaoui, Brahim; Muller, Olivier; Schläpfer, Jürg (October 2019). "Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention". The American Journal of Cardiology. 124 (8): 1305–1314. doi:10.1016/j.amjcard.2019.07.027. PMID 31455501. S2CID 201172222.
External links
[edit]- Further examples from Life in the Fast Lane Archived 2021-10-31 at the Wayback Machine