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De Winter T Waves

De Winter’s T Waves (anterior STEMI equivalent, acute proximal LAD occlusions)

Acute Proximal LAD Occlusion

Anterior STEMI equivalent anterior STEMI equivalent

De Winter T Waves

De Winter T waves, Tall, prominent, symmetric T waves in the precordial leads

De Winter T Waves and Wellens Syndrome



acute proximal LAD occlusion, De Winters T Waves

De Winter T Waves

  • Indicates proximal LAD occlusion
  • Patient has angina (chest pain)
  • Considered an equivalent of STEMI

ECG de winter T wave

ECG and De Winter T Waves

  • Changes are seen in V1-V6
  • Symmetrical high T waves
  • Ascending ST depression



acute proximal LAD stenosis, Wellens syndrome

Wellens Syndrome

  • Indicates critical proximal LAD stenosis
  • Patients do not have angina
  • STEMI develops within one week

ECG Wellens syndrome type I

ECG Wellens syndrome type II

ECG and Wellens Syndrome

  • Changes are seen in V2-V3
  • Wellens Syndrome has 2 types:
    • Symmetrical deep T waves (Type I)
    • Biphasic T waves (Type II)

ECG and De Winter T Waves

ECG criteria, De Winter T waves (V1-V6)

ECG exmplex of De Winter T waves, as STEMI quivalent

De Winter T Waves

  • In ECG, 8 patients (leads V1-V6)
  • Each patient has De Winter T waves (primarily in leads V2-V5)
    • Patients had acute proximal LAD occlusion


LAD occlusion, De Winter T waves
ECG De Winters T waves, upsloping ST depression with depression J point, Peaked anterior T waves, Subtle ST elevation aVR

De Winter T Waves



LAD occlusion, De Winter T waves
ECG De Winters T waves, upsloping ST depression, Peaked anterior T waves, Subtle ST elevation aVR

De Winter T Waves

  • High-peaked T waves (V2-V6)
    • Ascending ST depression (with J point depression > 1mm)
  • ST elevation up to 1mm (aVR)
  • The patient had symptoms of STEMI
  • De Winter T waves are considered an equivalent of STEMI


LAD occlusion, De Winter T waves
ECG De Winters T waves, upsloping ST depression, Peaked anterior T waves, Subtle ST elevation aVR

De Winter T Waves



LAD occlusion, De Winter T waves
ECG De Winters T waves and anterior STEMI infarction

De Winter T Waves and Anterior Wall STEMI

  • De Winter T waves are considered an equivalent of STEMI
    • De Winter T waves can therefore evolve into anterior wall STEMI
  • De Winter T waves
    • High-peaked T waves (V3-V6)
      • Ascending ST depression (with J point depression > 1mm)
    • ST elevation up to 1mm (aVR)
  • Acute anterolateral STEMI
  • The patient had symptoms of STEMI


acute LAD occlusion, De Winter T waves
ECG De Winters peaked T waves, anterior STEMI equivalent

De Winter T Waves



critical proximal left anterior descending artery (LAD)
ECG Wellens syndrome vs. De Winters T waves

Wellens' Syndrome (Type I)

  • Symmetrical deep negative T waves (V1-V6, aVL, I)
    • Changes may be rare (V1-V6), but are most commonly seen in (V2-V3)
  • Preserved R wave progression (R in V3 > 3mm)
  • The patient has asymptomatic critical proximal LAD stenosis
  • Left anterior hemiblock
  • Wellens' Syndrome



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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De Winter T Waves

De Winter’s T Waves (anterior STEMI equivalent, acute proximal LAD occlusions)

Acute Proximal LAD Occlusion
Anterior STEMI equivalent anterior STEMI equivalent

De Winter T Waves

  • Affects 2% of patients with acute proximal LAD occlusion
  • Considered an equivalent to STEMI
    • The patient has an acute occlusion of the proximal LAD
  • Patients are often not treated as STEMI because they have
    • ST depression
    • High peaked T waves (De Winter T waves)
De Winter T waves, Tall, prominent, symmetric T waves in the precordial leads

De Winter T Waves and Wellens Syndrome

acute proximal LAD occlusion, De Winters T Waves acute proximal LAD stenosis, Wellens syndrome

De Winter T Waves

  • Indicates proximal LAD occlusion
  • Patient has angina (chest pain)
  • Considered an equivalent of STEMI

Wellens Syndrome

  • Indicates critical proximal LAD stenosis
  • Patients do not have angina
  • STEMI develops within one week
ECG de winter T wave

ECG and De Winter T Waves

  • Changes are seen in V1-V6
  • Symmetrical high T waves
  • Ascending ST depression
 ECG Wellens syndrome type I ECG Wellens syndrome type II

ECG and Wellens Syndrome

  • Changes are seen in V2-V3
  • Wellens Syndrome has 2 types:
    • Symmetrical deep T waves (Type I)
    • Biphasic T waves (Type II)

ECG and De Winter T Waves
ECG criteria, De Winter T waves (V1-V6)


ECG exmplex of De Winter T waves, as STEMI quivalent

De Winter T Waves

  • In ECG, 8 patients (leads V1-V6)
  • Each patient has De Winter T waves (primarily in leads V2-V5)
    • Patients had acute proximal LAD occlusion


ECG De Winters T waves, upsloping ST depression with depression J point, Peaked anterior T waves, Subtle ST elevation aVR

De Winter T Waves

  • High-peaked T waves (V2-V6)
    • Ascending ST depression (with J point depression > 1mm)
  • ST elevation up to 1mm (aVR)
  • The patient had symptoms of STEMI
  • De Winter T waves are considered an equivalent of STEMI
 LAD occlusion, De Winter T waves


ECG De Winters T waves, upsloping ST depression, Peaked anterior T waves, Subtle ST elevation aVR

De Winter T Waves

  • High-peaked T waves (V2-V6)
    • Ascending ST depression (with J point depression > 1mm)
  • ST elevation up to 1mm (aVR)
  • The patient had symptoms of STEMI
  • De Winter T waves are considered an equivalent of STEMI
 LAD occlusion, De Winter T waves


ECG De Winters T waves, upsloping ST depression, Peaked anterior T waves, Subtle ST elevation aVR

De Winter T Waves

  • High-peaked T waves (V2-V6, I, II)
    • Ascending ST depression (with J point depression > 1mm)
  • ST elevation up to 1mm (aVR)
  • The patient had symptoms of STEMI
  • De Winter T waves are considered an equivalent of STEMI
 LAD occlusion, De Winter T waves


ECG De Winters T waves and anterior STEMI infarction

De Winter T Waves and Anterior Wall STEMI

  • De Winter T waves are considered an equivalent of STEMI
    • De Winter T waves can therefore evolve into anterior wall STEMI
  • De Winter T waves
    • High-peaked T waves (V3-V6)
      • Ascending ST depression (with J point depression > 1mm)
    • ST elevation up to 1mm (aVR)
  • Acute anterolateral STEMI
  • The patient had symptoms of STEMI
 LAD occlusion, De Winter T waves


ECG De Winters peaked T waves, anterior STEMI equivalent

De Winter T Waves

  • High-peaked T waves (V2-V5)
    • Ascending ST depression (with J point depression > 1mm)
  • ST elevation up to 1mm (aVR)
  • The patient had symptoms of STEMI
  • De Winter T waves are considered an equivalent of STEMI
 acute LAD occlusion, De Winter T waves


ECG Wellens syndrome vs. De Winters T waves

Wellens' Syndrome (Type I)

  • Symmetrical deep negative T waves (V1-V6, aVL, I)
    • Changes may be rare (V1-V6), but are most commonly seen in (V2-V3)
  • Preserved R wave progression (R in V3 > 3mm)
  • The patient has asymptomatic critical proximal LAD stenosis
  • Left anterior hemiblock
  • Wellens' Syndrome
 critical proximal left anterior descending artery (LAD)



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers