De Winter's T waves: Difference between revisions
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*First identified in 2008 by Dr. de Winter found a characteristic patterns in 30 of his 1532 patient database of anterior MI | *First identified in 2008 by Dr. de Winter found a characteristic patterns in 30 of his 1532 patient database of anterior MI | ||
*2% of proximal LAD occlusions will have this presentation | *2% of proximal LAD occlusions will have this presentation | ||
*Unlike Wellen's which refers to a subacute process, these T waves are an acute proximal occlusion | |||
*de Winter T-waves is a proposed STEMI-equivalent proposed by the AHA<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> | *de Winter T-waves is a proposed STEMI-equivalent proposed by the AHA<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> | ||
Revision as of 05:26, 31 August 2016
de Winter's T-waves as described below from his NEJM editorial[1]
Background
- First identified in 2008 by Dr. de Winter found a characteristic patterns in 30 of his 1532 patient database of anterior MI
- 2% of proximal LAD occlusions will have this presentation
- Unlike Wellen's which refers to a subacute process, these T waves are an acute proximal occlusion
- de Winter T-waves is a proposed STEMI-equivalent proposed by the AHA[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-Elevation Myocardial Infarction (STEMI)
- Wellens' syndrome
- STEMI equivalents
- T wave changes