The De Winter-like electrocardiogram pattern associated with multi-vessel disease.

Background: The de Winter ECG pattern was described by upsloping ST-segment depression in leads V1-V6, tall and symmetrical T waves in precordial leads. The ECG pattern is regarded to be associated with occlusion of the left anterior descending (LAD) artery.

Methods: One patient with de Winter ECG pattern was included. The 12-lead ECG of patients with chest pain showed upsloping ST-segment depression up to 3 mm at the J point in leads V2-V6; tall symmetrical T waves in leads V2-V4; 1mm J point elevation in lead aVR; ST-segment depression 1mm in I, aVL leads and inverted T waves in the inferior leads. The ECG was showed the de Winter pattern.

Results: The ECG was showed the de Winter pattern. CAG was performed, which showed the normal left main; 60%-80% LAD stenosis; 50%-60% ostial right coronary artery(RCA) stenosis; and 90% stenosis of the vessel at middle segment. Both proximal and middle RCA vascular lesions were dilated and successfully inserted with drug-eluting stents, respectively.

Conclusion: Our case the ECG was showed horizontal ST depression with tall T waves in leads V2-V4 (maximal ST depression in lead V4) while only ST depression in leads V5-V6, which may result from multivessel disease.