De Winter's T waves: Difference between revisions
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==Background== | ==Background== | ||
*First identified in 2008 by Dr. | *First identified in 2008 by Dr. DeWinter - characteristic pattern in 30 of his 1532-patient database of anterior MI<ref>de Winter R, et al. A new ECG sign of proximal LAD occlusion. NEJM. 2008; 359:2071–2073.</ref> | ||
*2% of proximal LAD occlusions will have this presentation | *2% of proximal LAD occlusions will have this presentation | ||
* | *Represents an acute proximal occlusion (unlike Wellen's sign which represents a subacute process) | ||
*Proposed [[STEMI]]-equivalent<ref>Rokos I, et al. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J. 2010;160:995–1003.</ref> | |||
[[File:Dewinter.jpg|thumb|DeWinter T Waves]] | |||
== | ==Clinical Features== | ||
*Precordial ST-segment depression at the J-point, 1-3 mm | |||
*Tall, peaked, symmetric T waves in the precordial leads | |||
*Lead aVR shows slight ST-segment elevation in most cases | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peaked T-waves DDX}} | |||
==Evaluation== | |||
*EKG | |||
*[[Troponin]] | |||
*CBC, metabolic panel | |||
*[[CXR]] | |||
==Management== | ==Management== | ||
*Rapid recognition of pattern | *Rapid recognition of pattern | ||
*Cath lab activation | *Cath lab activation (education of consultants may be necessary due to unfamiliarity) | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Acute | *[[Acute coronary syndrome (main)]] | ||
*[[ST- | *[[ST-segment elevation myocardial infarction (STEMI)]] | ||
*[[Wellens' syndrome]] | *[[Wellens' syndrome]] | ||
*[[STEMI equivalents]] | |||
*[[T wave changes]] | |||
==External Links== | ==External Links== | ||
[http://ekgumem.tumblr.com/post/19233090476/what-are-de-winter-t-waves-episode What are “de Winter T-waves”?] | *[http://ekgumem.tumblr.com/post/19233090476/what-are-de-winter-t-waves-episode What are “de Winter T-waves”?] | ||
*[https://litfl.com/de-winter-t-wave-ecg-library/ LITFL - De Winter T Wave] | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Cardiology]] | ||
Latest revision as of 21:03, 1 July 2021
Background
- First identified in 2008 by Dr. DeWinter - characteristic pattern in 30 of his 1532-patient database of anterior MI[1]
- 2% of proximal LAD occlusions will have this presentation
- Represents an acute proximal occlusion (unlike Wellen's sign which represents a subacute process)
- Proposed STEMI-equivalent[2]
Clinical Features
- Precordial ST-segment depression at the J-point, 1-3 mm
- Tall, peaked, symmetric T waves in the precordial leads
- Lead aVR shows slight ST-segment elevation in most cases
Differential Diagnosis
Peaked T-waves
- MI (hyperacute T waves)
- Hyperkalemia
- Benign Early Repolarization
- De Winter's T waves (acute LAD occlusion)
Evaluation
Management
- Rapid recognition of pattern
- Cath lab activation (education of consultants may be necessary due to unfamiliarity)
Disposition
- Admit
See Also
- Acute coronary syndrome (main)
- ST-segment elevation myocardial infarction (STEMI)
- Wellens' syndrome
- STEMI equivalents
- T wave changes