In Reply We would like to thank Drs Chen and An for their letter in response to our report in Challenges in Clinical Electrocardiography.1 They performed a thorough PubMed search of previous reports of an evolution between de Winter and Wellens syndromes on results of electrocardiogram (ECG). They found 2 similar cases, 1 by Samadov and colleagues2 in 2013 and another by Li and colleagues3 in 2019. Although there are some similarities with our case, there are important differences. The case by Samadov and colleagues2 recorded the de Winter pattern at chest-pain onset, but it was not until the next day that the transition to Wellens pattern was captured. The successive normal ECGs during the interval thus preclude this transition from being called a direct evolution. The case by Li and colleagues3 reported the occurrence of Wellens syndrome 40 minutes after the de Winter pattern was noted. Although the time frame was similar to that of our case, Li and colleagues recorded a type I Wellens syndrome (deeply inverted T waves) that evolved from de Winter syndrome; by contrast, the patient in our case presented with type II Wellens syndrome (biphasic T waves). It is worth noting that the change to Wellens frequently occurs during a pain-free interval4—true in the case reported by Li and colleagues as well as the case we reported.
Zhu Y, Luo S, Huang B. Urgent Intervention for Both de Winter and Wellens——Reply. JAMA Intern Med. 2022;182(3):356–357. doi:10.1001/jamainternmed.2021.7929
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