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July 4, 2015 De Winter ST/T-Waves Objective Understand and identify de Winter ST/T-waves as a STEMI equivalent De Winter ST/T-Waves ECG abnormality described by de Winter et al. in 1998 Characterized by 1-3 mm of ST-depression with upright, symmetrical T-waves Changes are dynamic as you would expect with ACS (see Example 3 below)
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de Winter syndrome is a rare phenomenon, and it occurs in approximately 2% of patients with myocardial infarction. 2 It has a high predictive value for LAD occlusion. 4 Recent studies suggested that de Winter syndrome may be a transient event before progressing into typical STEMI ECG. 5 The exact electrophysiologic mechanisms involved are not.
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de Winter syndrome is a special equivalent of anterior ST-segment elevation myocardial infarction (STEMI) characterized by the absence of overt ST-elevation with upsloping ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often associated with total occlusion of the proximal left anterior descending coronary art.
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The main criteria for De Winter sign are upsloping ST-segment depression by 0.1 mV at V1-V6 leads and tall symmetrical T waves [2]. Ideally, De Winter's sign-on electrocardiography should be treated as an ST-elevation myocardial infarct (STEMI) equivalent with early cardiac catheter lab activation for percutaneous coronary intervention [2].
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The De Winter ECG pattern has been reported to indicate acute left anterior descending coronary artery occlusion and is often considered to be an 'ST elevation myocardial infarction (STEMI) equivalent'.
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Case 2: A 34-year-old female presented with a 2-h history of ischaemic chest pain with initial ECG showing a de Winter's pattern. Due to concerns of performing PCI timeously, a pharmacoinvasive strategy of reperfusion was adopted with resolution of the de Winter's pattern. Urgent angiography revealed a proximal LAD lesion which was successfully.
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The de Winter's electrocardiogram (ECG) pattern signifying proximal left anterior descending (LAD) artery occlusion was first described in 2008. The ECG changes were thought to be static and mechanisms for this were suggested.
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De Winter syndrome is a type of acute coronary syndrome, which may be an early ECG pattern in the development of acute ST‐segment elevation myocardial infarction. Therefore, once De Winter syndrome is observed on the ECG, acute coronary syndrome, especially acute anterior descending occlusion should not be ignored.
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De Winter's T waves From WikEM Jump to: navigation, search Contents 1Background 2Clinical Features 3Differential Diagnosis 3.1Peaked T-waves 4Management 5See Also 6External Links 7References Background First identified in 2008 by Dr. DeWinter - characteristic pattern in 30 of his 1532-patient database of anterior MI[1]
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↑ de Winter R, et al. A new ECG sign of proximal LAD occlusion. NEJM. 2008; 359:2071-2073. ↑ Rokos I, et al. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J. 2010;160:995-1003.
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Thought to be first described by Dr. Robbert Jan de Winter in 2008 in his letter to the editor to the New England Journal of Medicine, the pattern of peaked T-waves as a sign of myocardial ischemia was actually first noted by Dr. William Dressler in 1947 in a case series of over 27 patients. What de Winter defined was "1- to 3-mm upsloping ST-segment depression at the J point in leads V1 to.
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de winter syndrome is a rare pattern that can occur on an electrocardiogram (ECG). 1 It is thought to be related to acute anterior descending artery occlusion. 1 ST-segment elevation myocardial infarction (STEMI) equivalent patterns make the diagnosis of STEMI very challenging. 1 The ECG reveals a de Winter's pattern, which shows a 1 to 3 mm ups.
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The de Winter pattern is seen in ~2% of acute LAD occlusions and is often under-recognised by clinicians Key diagnostic features include ST depression and peaked T waves in the precordial leads
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An electrocardiographic finding suggestive of impending myocardial infarction , the de Winter's pattern (or "de Winter's T-waves") describes an abnormality thought to be indicative of acute occlusion of the proximal left anterior descending coronary artery ( LAD) 2.
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In 2008, de Winter et al described an ECG pattern suggesting that it should be considered an ST‐elevation myocardial infarction (STEMI) equivalent (de Winter, Verouden, Wellens, & Wilde, 2008 ), with the potential to predict critical stenosis or occlusion of the left anterior descending coronary artery (LAD). This ECG pattern typically.