DeWinter's T-Waves

Definition

Early warning of an evolving STEMI.

History/Physical Exam

History and findings suggestive of acute coronary syndrome.

Key 12-Lead Features

• J-Point depression with up-sloping ST segments. 
• Tall, prominent, symmetric T waves in the precordial leads.
• Upsloping ST segment depression > 1mm at the J-point in the precordial leads.
• Absence of ST elevation in the precordial leads.
• ST segment elevation (0.5mm-1mm) in aVR.
• “Normal” STEMI morphology may precede or follow the DeWinter pattern.

Key Treatment Points

• Patient advocacy for a cardiology consult
• Monitor for potential emerging STEMI

12 Lead ECG Samples

Further Reading

References

1. DeWinter et al. A new ECG sign of proximal LAD occlusion. 2008. [Link]