ECG Case 019

Middle aged patient presenting with chest pain and diaphoresis. What does the ECG show?

ECG courtesy of Mat Goebel

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.
ECG de Winter T-waves V3 strip

CLINICAL PEARLS

The De Winter ECG pattern may evolve into (or even evolve from) a more classic STEMI pattern.

ECG De Winter T waves 12 lead 2

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 | Eponyms | Books | vocortex |

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