De Winter syndrome

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de Winter syndrome
Other names: de Winter pattern,[1] de Winter T waves,[2] 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
SymptomsChest pain, shortness of breath[1]
Usual onsetSudden[1]
CausesBlockage of the left anterior descending artery (LAD)[1]
Diagnostic methodECG[1]
Differential diagnosisHigh potassium, tachycardia, benign early repolarization[1][3]
TreatmentAs per ST elevation MI (STEMI)[1][4]
Frequency2.5% of anterior MIs[1]

de Winter syndrome is an electrocardiogram (ECG) pattern which often represents sudden near blockage of the left anterior descending artery (LAD).[1][5] Symptoms include chest pain, shortness of breath, and sweating.[1]

While typically due to blockage of the LAD, other arteries of the heart may be involved.[1] Risk factors are similar to other types of ischemic heart disease.[1] The underlying mechanism is unclear; though may involve subendocardial ischemia or collateral circulation.[1]

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.[1] The ST-segment is upsloping and there is also often ST-segment elevation of 0.5 to 2 mm in lead aVR.[1][2] The QRS complex is either normal or slightly wide.[1]

Treatment is as per an ST elevation MI (STEMI), with primary percutaneous coronary intervention (PCI) being prefered.[1][4] De Winter syndrome is uncommon, representing about 2 to 3% of people with anterior MIs.[1] Males are more commonly affected than females.[1] It was first described in 2008 by Robbert J. de Winter.[1][2]


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 Vilela, EM; Braga, JP (January 2022). "DeWinter Pattern". PMID 32491505. {{cite journal}}: Cite journal requires |journal= (help)
  2. 2.0 2.1 2.2 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". Archived from the original on 2021-05-07. Retrieved 2022-07-28.
  4. 4.0 4.1 4.2 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. 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.

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