A rare pattern in the setting of acute coronary occlusion (OMI), it is considered a STEMI equivalent and is very frequently associated with thrombotic occlusion or subocclusion of the left anterior descending artery.

Electrocardiographic Criteria

  • Upsloping ST-segment depression in leads V1-V2 to V6
  • Peaked, tall, symmetric T waves (hyperacute T waves)

ECG in the “de Winter” Pattern

Electrocardiogram with the de Winter pattern

“de Winter” pattern. Characteristic J-point depression followed by an upsloping ST segment and hyperacute T waves from V2 to V6.

Further Reading

References

  1. Felicioni SP, de Alencar Neto JN, Centemero MP, Lourenço UR, De Marchi MFN, Scheffer MK, et al. The de Winter electrocardiographic pattern: A systematic review of case reports. J Electrocardiol. 2024 Nov;153821.
  2. de Winter RJ, Verouden NJW, Wellens HJJ, Wilde AAM. A New ECG Sign of Proximal LAD Occlusion. N Engl J Med. 2008;359(19):2071–3.
  3. Verouden NJ, Koch KT, Peters RJ, Henriques JP, et al. Persistent precordial “hyperacute” T-waves signify proximal left anterior descending artery occlusion. Heart. 2009;95(20):1701–6.