循環器ジャーナル69巻2号

2021年04月発行

特集 エキスパートに学ぶ 知っておきたい心電図診断のコツと落とし穴 虚血性心疾患

Topics:de Winter Pattern

著者： 堤勝彦¹ 小菅雅美¹ 木村一雄¹

所属機関： ¹横浜市立大学附属市民総合医療センター心臓血管センター

ページ範囲：P.186 - P.190

Point
・de Winter Patternは，前胸部誘導でST上昇を呈さずupsloping型のST低下と連続する増高した左右対称性の陽性T波を呈し，aV_R誘導のST上昇を伴う特異なST-T変化である．
・de Winter PatternはLAD近位部閉塞を示唆する心電図所見で，この所見はST上昇と同様に考え再灌流療法の適応となる．

参考文献

1) Kimura K, Kimura T, Ishihara M, et al:JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. Circ J 83:1085-1196, 2019

2) de Winter RJ, Verouden NJW, Wellens HJJ, et al:A new ECG sign of proximal LAD occlusion. N Engl J Med 359:2071-2073, 2008

3) Goebel M, Bledsoe J, Orford JL, et al:A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr. Am J Emerg Med 32:287, 2014

4) Goktas MU, Sogut O, Yigit M, et al:A Novel Electrocardiographic Sign of an ST-Segment Elevation Myocardial Infarction-Equivalent:De Winter Syndrome. Cardiology Res 8:165-168, 2017

5) Xu J, Wang A, Liu L, et al:The de Winter electrocardiogram pattern is a transient electrocardiographic phenomenon that presents at the early stage of ST-segment elevation myocardial infarction. Clin Cardiol 41:1177-1184, 2018

6) Morris NP, Body R:The De Winter ECG pattern:morphology and accuracy for diagnosing acute coronary occlusion. Eur J Emerg Med 24:236-242, 2017

7) de Winter RW, Adams R, Amoroso G, et al:Prevalence of junctional ST-depression with tall symmetrical T-waves in a pre-hospital field triage system for STEMI patients. J Electrocardiol 52:1-5, 2019

8) Thygesen K, Alpert JS, Jaffe AS, et al:Fourth universal definition of myocardial infarction（2018）. Circulation 138:e618-e651, 2018

9) Birnbaum Y, Fiol M, Nikus K, et al:A counterpoint paper:Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction. J Electrocardiol 60:142-147, 2020

10) Tsutsumi K, Tsukahara K:Is the diagnosis ST-segment elevation or non-ST-segment elevation myocardial infarction? Circulation 138:2715-2717, 2018