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 becoming increasingly recognised as an anterior STEMI equivalent (~2% of LAD occlusions).
Some authors are now recommending that this ECG pattern be treated identically to anterior STEMI, with urgent PCI or thrombolysis.