De Winter's T waves: Difference between revisions
No edit summary |
(Text replacement - "*Troponin" to "*Troponin") |
||
| Line 17: | Line 17: | ||
==Evaluation== | ==Evaluation== | ||
*EKG | *EKG | ||
*Troponin | *[[Troponin]] | ||
*CBC, metabolic panel | *CBC, metabolic panel | ||
*CXR | *CXR | ||
Revision as of 20:54, 1 July 2019
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