De Winter T Wave

Aka: De Winter T Wave

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II. Epidemiology

  1. De Winter T Waves are seen in 2% of Left Anterior Descending coronary lesions

III. Criteria

  1. Hyperacute T Waves with J Point Depression
    1. J Point depression 1-3 mm with upsloping ST Segment in leads V1 to V6 AND
    2. Tall, prominent, hyperacute precordial T Waves
  2. Other findings
    1. No ST Segment Elevation in precordial leads
    2. Narrow QRS typically
    3. ST Segment Elevation in aVR

IV. Interpretation

  1. Hyperacute T Waves with J Point Depression suggests acute Occlusion of the LAD Coronary Artery
  2. May be STEMI Equivalent
    1. Monitor with serial EKGs and consult cardiology
    2. Consider urgent to emergent Percutaneous Coronary Intervention

V. Differential Diagnosis

  1. See Hyperacute T Wave
    1. Other Hyperacute T Waves typically evolve over time
    2. In contrast, De Winter T Wave persists over time
  2. Hyperkalemia
  3. ST Elevation Myocardial Infarction (STEMI)
    1. T Wave widens with increased height as an early change in STEMI, often prior to ST Elevation

VI. References

  1. emDocs
    1. http://www.emdocs.net/hyperacute-t-waves/
  2. Life in the fast Lane
    1. https://litfl.com/de-winter-t-wave-ecg-library/

VII. References

  1. Shoenberger and Swaminathan in Swadron (2023) EM:Rap 23(5): 1-2
  2. de Winter (2008) N Engl J Med 359(19):2071-3 +PMID:18987380

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