The de Winter ECG pattern occurred after ST-segment elevation in a patient with chest pain

  • Rex Pui Kin LamEmail author
  • Arthur Chi Kin Cheung
  • Abraham Ka Chung Wai
  • Ronald Tat Ming Wong
  • Tak Sun Tse

Case description

A previously healthy 58-year-old male hospital staff member presented to the emergency department (ED) with chest pain, which had started several minutes ago. He was haemodynamically stable with no clinical evidence of heart failure. The first electrocardiogram (ECG) taken 6 min after arrival showed ST-segment elevation in leads I, aVL and V2–6, with ST depression and T wave inversion in lead III, suggestive of an acute anterolateral myocardial infarction (MI) (Fig.  1a). He was treated with aspirin, ticagrelor, nitroglycerin sprays, intravenous morphine and metoclopramide in the ED with relief of chest pain. The initial high-sensitivity cardiac troponin-T level was not elevated. The second ECG taken 28 min after arrival revealed upsloping ST-segment depression > 1 mm at the J point and tall, symmetrical T wave in leads V1–V4, which was compatible with the de Winter ECG pattern (Fig.  1b). The patient underwent transradial coronary arteriography 55 min after the second...


Author contributions

Cheung ACK, Wai AKC and Tse TS treated the patient and recorded clinical findings. Wong RTM performed literature review. Lam RPK and Cheung ACK wrote the first draft of the manuscript. Wai AKC, Wong RTM and Tse TS critically reviewed the manuscript and revised it. Tse TS provided the pictures of coronary angiogram.


The authors did not receive any funding support in writing up this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

The authors indicate that all procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animal subject was involved in this study.

Informed consent

A written informed consent for publication was obtained from the patient. We declare that no work resembling the enclosed article has been published or is being submitted for publication elsewhere. We certify that we have each made a substantial contribution so as to qualify for authorship and that we have reviewed and approved the content of the article. No portion of the text has been copied from other material in the literature.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Emergency Medicine Unit, Li Ka Shing Faculty of MedicineThe University of Hong KongPokfulamChina
  2. 2.Department of CardiologyGleneagles Hong Kong HospitalWong Chuk HangChina

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