Baldisserotto Hugo Leonardi, Daga Andressa, Heiden Telo Guilherme
Internal Medicine Department, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos, 2400, 90610-264 Porto Alegre/RS, Brazil.
Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, 90035-003 Porto Alegre/RS, Brazil.
Eur Heart J Case Rep. 2025 Jul 24;9(8):ytaf354. doi: 10.1093/ehjcr/ytaf354. eCollection 2025 Aug.
ST-segment elevation on electrocardiogram (ECG) is traditionally interpreted as acute coronary occlusion, with a sensitivity of approximately 75%. Electrocardiographic patterns such as 'Wellens' and 'De Winter' have been studied as ST-segment elevation myocardial infarction (STEMI) equivalents.
A 79-year-old hypertensive woman was admitted with chest pain radiating to the neck. The initial ECG showed a left bundle branch block with a 'De Winter' pattern. After initial care, she underwent cardiac catheterization that revealed thrombotic occlusion of the left anterior descending artery. She underwent angioplasty with angiographic success and clinical improvement, leading to hospital discharge.
Recognition of electrocardiographic patterns associated with acute coronary occlusion is crucial for diagnosis and prompt reperfusion, reducing morbidity and mortality. The 'De Winter' pattern is an equivalent to STEMI. Patients with pre-existing conditions that affect QRS amplitude and width, such as the left bundle branch block, pose an additional challenge.
心电图（ECG）上的ST段抬高传统上被解释为急性冠状动脉闭塞，敏感性约为75%。诸如“Wellens”和“De Winter”等心电图模式已作为ST段抬高型心肌梗死（STEMI）的等效情况进行研究。
一名79岁的高血压女性因胸痛放射至颈部入院。初始心电图显示左束支传导阻滞伴“De Winter”模式。经过初始治疗后，她接受了心脏导管插入术，结果显示左前降支动脉血栓闭塞。她接受了血管成形术，血管造影成功且临床症状改善，随后出院。
识别与急性冠状动脉闭塞相关的心电图模式对于诊断和及时再灌注至关重要，可降低发病率和死亡率。“De Winter”模式等同于STEMI。患有影响QRS波幅和宽度的既往疾病（如左束支传导阻滞）的患者会带来额外挑战。
