De Winter Pattern: Anterior St-Elevation Myocardial Infarction Equivalent

De winter syndrome is an unusual pattern that can occur on an electrocardiogram (ECG). The de Winter pattern was first described by de Winter and colleagues in 2008 as a pattern of ECG that is associated with anterior myocardial infarction associated with left anterior descending (LAD) artery occlusion. The ECG characteristics are Upsloping ST segment depression > 1mm at the J point in the precordial leads followed by Tall, prominent, symmetrical T waves in the precordial leads, other additional characteristics are slight ST-segment elevation in aVR and Absence of ST elevation in the precordial leads. The de Winter pattern is seen in ~2% of acute LAD occlusions and is often under-recognised by clinicians. The electrophysiological explanation of the observed ECG pattern is still unclear. Early reports of the de Winter pattern suggested that the ECG pattern is static, however there are cases reports where the de Winter pattern evolved from, or evolved to, a “classic” anterior STEMI. ST‐segment elevation myocardial infarction (STEMI) equivalent patterns make the diagnosis of STEMI very challenging.