de Winter ECG Pattern for Proximal LAD Occlusion
de Winter's ECG pattern: STEMI-equivalent caused by proximal LAD occlusion but without ST elevation. Characterised by upsloping ST depression + tall peaked T waves in precordial leads. Requires immediate reperfusion.
Score interpretation
→ de Winter pattern confirmed: STEMI-equivalent. Proximal LAD occlusion. Activate cardiac catheterisation laboratory immediately — same urgency as STEMI. Aspirin 300 mg + ticagrelor 180 mg (or prasugrel 60 mg); heparin; do NOT wait for troponin. Cardiology and cath lab team alert NOW.
→ Probable de Winter pattern. Treat as STEMI equivalent; immediate cath lab consideration; serial ECGs (pattern may evolve to ST elevation); aspirin + P2Y12; anticoagulation; continuous monitoring; cardiology review urgently.
→ de Winter pattern not confirmed. Consider: Posterior MI (check V7-V9), hyperkalaemia (peaked T waves), early repolarisation, LVH. Serial ECGs every 15 minutes; troponins; echo; cardiology assessment.
Interpretation bands for the de Winter Pattern. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Fridericia Corrected QT Interval (QTcF) · ECG Interpretation
- Modified Sgarbossa's Criteria (Smith Modification) for MI in LBBB · ECG Interpretation
- Brugada Phenocopy Score · ECG Interpretation
- Wellens Syndrome ECG Pattern · ECG Interpretation
- Lead aVR Sign for Left Main / Proximal LAD Occlusion · ECG Interpretation
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.