De Winter ST-segment pattern on ECG — upsloping ST depression at the J-point with tall, peaked T waves in precordial leads V1–V6 — is equivalent to STEMI and indicates occlusion of which vessel?

• A Right coronary artery (proximal)
• B Left circumflex artery
• C Left main coronary artery
• D Left anterior descending artery (proximal LAD) ✓

Explanation

The De Winter pattern consists of J-point ST depression with upsloping ST segments and tall, symmetric T waves in V1–V6, often with slight ST elevation in aVR. It represents acute occlusion of the proximal LAD — a STEMI equivalent requiring emergency primary PCI. Critically, this pattern does not show conventional ST elevation and may be missed without specific knowledge. It occurs in approximately 2% of anterior STEMIs.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.