Published: December 15th, 2015

Category: STEMI

Emergency Department ECG


Cardiac Cath Report

LM– Normal caliber, no angiographic stenosis

LAD100% occlusion proximal vessel

LCx- Normal caliber, no angiographic stenosis proximal vessel

RCA– Normal caliber , dorminant vessel with mild diffuse disease. PDA/ PLV patent



De Winters T Waves

  • The de Winter ECG pattern is an anterior STEMI equivalent that presents without obvious ST segment elevation.
  • Key diagnostic features include ST depression and peaked T waves in the precordial leads.
  • The de Winter pattern is seen in ~2% of acute LAD occlusions and is under-recognised by clinicians.

Diagnostic Criteria

  • 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



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