De Winter's T waves
- First identified in 2008 by Dr. DeWinter - characteristic pattern in 30 of his 1532-patient database of anterior MI
- 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
- 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
- CBC, metabolic panel
- Rapid recognition of pattern
- Cath lab activation (education of consultants may be necessary due to unfamiliarity)
- 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.