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
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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- The de Winter electrocardiographic pattern of proximal left anterior descending occlusion.Am J Emerg Med. 2017; 35: 937.e1-937.e3
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Article info
Publication history
Published online: November 29, 2017
Accepted:
November 24,
2017
Received:
November 14,
2017
Footnotes
See page 209.e3 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Does This ECG Really Present a de Winter ECG Pattern?Canadian Journal of CardiologyVol. 35Issue 10
- PreviewWe 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.
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- Preview
- Going Beyond Left Anterior Descending Artery Occlusion: Recognizing the Variable Clinical Associations of the de Winter Pattern on ElectrocardiographyCanadian Journal of CardiologyVol. 34Issue 3
- PreviewWe 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.
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