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
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 asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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

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