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.
TOP 100 ECG SERIES
MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner