Table of Contents

Introduction
ECG features
Mx

de Winter syndrome

see also:

Introduction

de Winter syndrome is an uncommon ECG pattern in patients with acute ischaemic chest pain which is found in 2% of acute LAD occlusions and is an indication for urgent coronary angiography in the same way that a acute myocardial infarction (AMI/STEMI/NSTEMI) is.
it was 1st reported in 2008
tends to be more common in younger males with hypercholesterolaemia

ECG features

Up-sloping ST segment depression ( > 1 mm) at the J-point esp. in V2-4
Tall, prominent, symmetric upright (“hyperacute”) T waves in precordial leads
- ascending limb of the T wave commences below the isoelectric baseline
no ST elevation in precordial leads
0.5-1mm ST elevation in aVR
may be precede by, or followed by development of a “normal” STEMI pattern

Mx

as per acute myocardial infarction (AMI/STEMI/NSTEMI)
if doubt exists, consider bedside echocardiography to confirm the anterior LV dyskinesia due to ischaemia