ECG Case 062

Middle aged patient presenting with chest pain and diaphoresis. Describe and interpret his ECG

TOP 100 ECG QUIZ LITFL 062

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities

  • ST depression in V2-6, 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’s T waves” (also see ECG 019)
  • 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.
de Winter T-waves
Typical De Winter T Wave

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Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

2 Comments

  1. Any comment about the rythm? The axis of the P wave (Negative in DII Positive in AVR) makes you think its an auricular rythm.

  2. To me these resemble the Peaked T waves of Hyperkalemia?

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