Total Occlusion of Anterior Descending Artery (AD) without ST-Segment Elevation: DE Winter Pattern

The recognition of the presence of ST-segment elevation in the context of ACS (acute coronary syndrome) is fundamental for the good outcome of the case. However, some electrocardiographic patterns have been highlighted by the fact that there is no elevation, but they represent a severity similar to ACS with ST elevation. Hence, it is necessary that doctors who do the first service recognize these standards promptly.The electrocardiographic pattern of association between the ST-segment depression and the hyperacute T waves representing myocardial infarction in the anterior wall, localizing more specifically in the anterior descending artery, now known as the De Winter pattern, was first described by Dressler, and then described by Winter six years later. Winter observed that, out of a series of 1,452 cases, 2% of patients with anterior wall infarction had the pattern of ST-segment depression, positive and symmetrical T waves, and occasionally mild ST-segment elevation at AVR derivation. Those patients are admitted to the emergency room with a typical chest pain. However, because the electrocardiographic findings of this syndrome are not known to many health professionals, in many cases the patients do not receive adequate care and have fatal outcome, since mortality is relevant in these cases. Thus, the rapid recognition of this pattern is extremely necessary for the correct and effective intervention.