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.
CLINICAL PEARLS
The De Winter ECG pattern may evolve into (or even evolve from) a more classic STEMI pattern.
TOP 100 ECG SERIES
Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane
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