The Critical Importance of Recognizing De Winter's T-wave Pattern: A Case of Acute Proximal LAD Occlusion by In-Stent Restenosis

TL;DR

A case shows how recognizing De Winter's T-wave pattern on an ECG is crucial for timely treatment of a severe heart condition.

Contribution

This case emphasizes the urgent need to identify De Winter's T-wave pattern to prevent delays in reperfusion therapy.

Findings

De Winter's T-wave pattern was identified in a patient with acute LAD occlusion due to in-stent restenosis.

The patient's condition improved after urgent treatment with a drug-coating balloon.

High-sensitivity troponin I levels indicated significant cardiac damage.

Abstract

De Winter's T-wave pattern is a high-risk ST-elevation myocardial infarction (STEMI) equivalent signifying acute proximal left anterior descending (LAD) occlusion, characterized by precordial upsloping ST-depression and tall, peaked T-waves. We present a 69-year-old man with chest pain whose electrocardiogram (ECG) showed a classic De Winter's pattern. He rapidly developed acute respiratory failure, and his high-sensitivity troponin I peaked at >27,027 pg/mL. Urgent angiography identified severe in-stent restenosis (ISR) in the proximal-mid LAD as the culprit lesion. This was successfully treated with a drug-coating balloon. This case highlights that De Winter's pattern is a critical finding that must be immediately recognized to prevent delays in emergent reperfusion therapy.

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