De Winter's T waves: Difference between revisions
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*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) | *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> | *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]] | [[File:Dewinter.jpg|thumb|DeWinter T Waves]] | ||
Revision as of 00:52, 20 March 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)
Management
- Rapid recognition of pattern
- Cath lab activation (education of consultants may be necessary due to unfamiliarity)
See Also
- Acute coronary syndrome (main)
- ST-segment elevation myocardial infarction (STEMI)
- Wellens' syndrome
- STEMI equivalents
- T wave changes