September 10, 2025SHILAP Revista de lepidopterología2 citationsOpen Access

The dynamic evolution of the de Winter ECG pattern that is easily overlooked and life-threatening: a case report and literature review

YCYingmei ChenJiangxi University of Traditional Chinese Medicine ZCZhiqin ChenGuangdong University of Technology LZLili ZhangHainan General Hospital

Structured PICO

Population

2 patients presenting with chest pain and a de Winter ECG pattern, plus cases from literature review

Outcome

Evolution of ECG pattern and presence of severe coronary artery stenosissurrogate

The de Winter ECG pattern is a dynamic early manifestation of ACS that indicates severe coronary stenosis and requires urgent coronary angiography.

Abstract

These two cases and the literature review indicated that the de Winter ECG pattern is dynamically evolving. Its ECG pattern evolution is variable, progressing to STEMI, NSTEMI, Wellens, or even a normal. In patients presenting with chest pain, a de Winter ECG pattern, regardless of the subsequent dynamic evolution of the ECG, indicates the presence of severe coronary artery stenosis. The de Winter ECG pattern may be an early manifestation of ACS and requires urgent coronary angiography to save the patient's life and improve prognosis.

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