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Canadian Journal of Cardiology

The de Winter ECG Pattern in the Absence of Acute Coronary Artery Occlusion

Published:November 29, 2017DOI:https://doi.org/10.1016/j.cjca.2017.11.014

      Abstract

      A 26-year-old man presented to the emergency department with chest pain and electrocardiogram (ECG) changes compatible with the de Winter pattern. Emergent coronary angiography was used to rule out the presence of significant stenosis. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis. This case underlines the lack of data regarding the positive predictive value of this ECG pattern for the diagnosis of acute myocardial infarction. Until further prospective studies are available, we believe that the de Winter ECG pattern should be considered as an “ST-elevation equivalent” when myocardial ischemia is suspected.

      Résumé

      Un homme de 26 ans se présente à l’urgence en se plaignant de douleurs thoraciques et en présentant des changements électrocardiographiques (ECG) correspondant au complexe de de Winter. Une coronarographie d’urgence est effectuée afin d’exclure la possibilité d’une sténose importante. Le diagnostic de myocardite est confirmé à l’imagerie par résonnance magnétique cardiaque. Ce cas illustre le manque de données relatives à la valeur prédictive positive de ce type de tracé électrocardiographique dans le diagnostic d’infarctus aigu du myocarde. Jusqu’à ce que les résultats d’autres études prospectives soient publiés, nous croyons que le complexe de de Winter doit être considéré comme équivalent d’un sus-décalage du segment ST lorsqu’une ischémie myocardique est soupçonnée.
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      References

      1. Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) [e-pub ahead of print]. Eur Heart J https://doi.org/10.1093/eurheartj/ehx393, accessed November 14, 2017.

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      Linked Article

      • Does This ECG Really Present a de Winter ECG Pattern?
        Canadian Journal of CardiologyVol. 35Issue 10
        • Preview
          We read with interest the case reported by García-Izquierdo et al.1 in an issue of the Canadian Journal of Cardiology. The authors present a very interesting case of a patient with chest pain and electrocardiograhic (ECG) changes compatible with the de Winter ECG pattern, in which the diagnosis of myocarditis was ultimately confirmed by cardiac magnetic resonance and coronary angiography. Unfortunately, we think that the ECG (Fig. 1) that the authors analyzed does not represent the “de Winter ECG pattern” described by de Winter and colleagues.
        • Full-Text
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      • Going Beyond Left Anterior Descending Artery Occlusion: Recognizing the Variable Clinical Associations of the de Winter Pattern on Electrocardiography
        Canadian Journal of CardiologyVol. 34Issue 3
        • Preview
          We read with keen interest the case reported by García-Izquierdo et al.1 in a recent issue of the Canadian Journal of Cardiology. The authors' contribution is greatly appreciated because it illustrates the danger of yoking a pattern on the electrocardiogram (ECG) to an eponymous syndrome. García-Izquierdo et al. report a 26-year-old man who presented with exertional chest pain radiating to the left arm, marked elevation of troponin I levels at 15.62 μg/L (normal value < 0.06 μg/L) and the classic ECG of anterior upsloping ST-segment depression with tall T waves first described by de Winter et al.
        • Full-Text
        • PDF