De Winter's T waves

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

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

External Links

What are “de Winter T-waves”?

References

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

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