De Winter sign on ECG is detected in 2% of patients with critical stenosis or occlusion of the left anterior descending artery. Some authors consider it as STEMI equivalent.
Diagnostic criteria include:
- upsloping ST segment depression more than 1 mm at the J-point in the precordial leads
- tall, hyperacute symmetric T waves in the precordial leads
- ST segment elevation in aVR
- absence of ST segment elevation in the precordial leads.
This feature may be transitory. And ST segment elevation may be detected before or after de Winter sign.
