ECG Case 019
Middle aged patient presenting with chest pain and diaphoresis.
What does the ECG show?
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
Main Abnormalities
- ST depression in V2-5, which slopes upwards and joins the ascending limb of the T wave
- Prominent, “rocket-shaped” T waves in the precordial leads V2-5
- Subtle ST elevation in aVR
Diagnosis
- This combination of ST depression with rocket-shaped T waves in the precordial leads V1-6 is referred to as the De Winter ECG pattern or “De Winter T waves”
- It is now recognised as an anterior STEMI equivalent (~2% of LAD occlusions), and should be treated identically to anterior STEMI, with urgent PCI or thrombolysis
CLINICAL PEARLS
The De Winter ECG pattern may evolve into (or even evolve from) a more classic STEMI pattern.
References
Further Reading
- Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
- Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
- Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
- Rawshani A. Clinical ECG Interpretation ECG Waves
- Smith SW. Dr Smith’s ECG blog.
- Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF
TOP 100 ECG Series
Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Co-creator of the LITFL ECG Library. Twitter: @rob_buttner