De Winter's T waves: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peaked T-waves DDX}} | {{Peaked T-waves DDX}} | ||
==Evaluation== | |||
*EKG | |||
*Troponin | |||
*CBC, metabolic panel | |||
*CXR | |||
==Management== | ==Management== | ||
*Rapid recognition of pattern | *Rapid recognition of pattern | ||
*Cath lab activation (education of consultants may be necessary due to unfamiliarity) | *Cath lab activation (education of consultants may be necessary due to unfamiliarity) | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
Revision as of 17:41, 28 June 2017
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
- EKG
- Troponin
- CBC, metabolic panel
- CXR
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