De Winters T waves

***ANTERIOR STEMI EQUIVALENT ALERT***

The aims of this post is really to educate and alert all emergency ambulance staff, emergency department physicians and interventional cardiologists, that are involved in the care of STEMI patients in the recognition of de Winters T waves high-risk ECG pattern. 

I hope to achieve by doing so, more lives and myocardial muscle could be saved in the future. These patient's need to receieve emergent reperfusion therapy with PCI or thrombolysis. 

Please share this post and educate others practitioners about De Winters T waves :) 

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
• de Winter T-waves is a proposed STEMI-equivalent proposed by the AHA

Diagnostic Features

1. Precordial ST-segment depression at the J-point, 1-3 mm
2. Tall, peaked, symmetric T waves in the precordial leads
3. Lead aVR shows slight ST-segment elevation in most cases

Figure 1: 12-lead ECG showing De Winters T waves, (ECG above and below is courtesy of Dr Steve Smith, check out his excellent blog) @: http://hqmeded-ecg.blogspot.co.uk/

Figure 2: Blue arrows show hyper acute T waves, Red arrows show ST depression

Figure 3: 8 patient's examples of de Winters T waves, all patient's had LAD occlusion.

Figure 4:

Figure 5: Please save this study card and share it with your friends and colleagues, the more emergency medical staff that recognize this high risk pattern, then more lives could be saved  

Differential Diagnosis:

- Peaked T-waves
- MI (hyperacute T waves)
- Hyperkalemia
- Benign Early Repolarization
- De Winter's T waves (acute LAD occlusion)

References and links

* http://hqmeded-ecg.blogspot.co.uk/2009/02/hyperacute-t-waves.html
* http://lifeinthefastlane.com/ecg-library/de-winters-t-waves/