De Winter's T waves

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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]
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

Peaked T-waves

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

External Links

References

  1. de Winter R, et al. A new ECG sign of proximal LAD occlusion. NEJM. 2008; 359:2071–2073.
  2. 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.