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de Winter syndrome
Other names	de Winter pattern, de Winter T waves, 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
Usual onset	Sudden
Causes	Blockage of the left anterior descending artery (LAD)
Diagnostic method	ECG
Differential diagnosis	High potassium, tachycardia, benign early repolarization
Treatment	As per ST elevation MI (STEMI)
Frequency	2.5% of anterior MIs
Deaths	High

de Winter syndrome is an electrocardiogram (ECG) pattern which often represents sudden near blockage of the left anterior descending artery (LAD). Symptoms include chest pain, shortness of breath, and sweating.

While typically due to blockage of the LAD, other arteries of the heart may be involved. Risk factors are similar to other types of ischemic heart disease. The underlying mechanism is unclear; though may involve subendocardial ischemia or collateral circulation.

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. The ST-segment is upsloping and there is also often ST-segment elevation of 0.5 to 2 mm in lead aVR. The QRS complex is either normal or slightly wide.

Treatment is as per an ST elevation MI (STEMI), with primary percutaneous coronary intervention (PCI) being preferred. De Winter syndrome is uncommon, representing about 2 to 3% of people with anterior MIs. Males are more commonly affected than females. It was first described in 2008 by Robbert J. de Winter.

References

1. ^ Vilela, EM; Braga, JP (January 2022). "DeWinter Pattern". StatPearls. PMID 32491505.
2. ^ 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.
3. "De Winter's T waves - WikEM". wikem.org. Archived from the original on 2021-05-07. Retrieved 2022-07-28.
4. ^ 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.
5. 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

• Further examples from Life in the Fast Lane Archived 2021-10-31 at the Wayback Machine

• Ischemic heart diseases