From the Research
De-Winter's T-wave is a critical electrocardiogram (ECG) pattern that represents an acute proximal left anterior descending (LAD) coronary artery occlusion, which is a type of STEMI equivalent, and requires immediate cardiac catheterization lab activation and standard STEMI management. This pattern shows upsloping ST-segment depression with tall, prominent, symmetric T-waves in the precordial leads (V1-V6), often with ST elevation in lead aVR 1. The de Winter ECG pattern is a transient and dynamic phenomenon that reflects proximal or mid-LAD subtotal occlusion rather than total occlusion, and it may evolve into a typical STEMI pattern 2.
Clinical Presentation and Diagnosis
The de Winter ECG pattern occurs in approximately 2% of acute LAD occlusions and carries a high mortality risk if not promptly recognized and treated 1. The pathophysiology involves transmural ischemia affecting the anterior wall of the left ventricle, creating unique electrical vectors that produce this distinctive ECG pattern rather than the classic ST-segment elevation seen in most STEMIs.
Management and Treatment
When you identify De-Winter's T-waves on an ECG, immediate cardiac catheterization lab activation is necessary, as this pattern indicates a critical, potentially life-threatening coronary occlusion requiring urgent reperfusion therapy 1, 3. While waiting for catheterization, standard STEMI management should be initiated, including aspirin 325mg, P2Y12 inhibitors like ticagrelor 180mg or clopidogrel 600mg loading dose, anticoagulation with heparin, and pain management.
Key Points
- De-Winter's T-wave is a STEMI equivalent that requires immediate cardiac catheterization lab activation and standard STEMI management.
- The de Winter ECG pattern is a transient and dynamic phenomenon that reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.
- Prompt recognition and treatment of the de Winter ECG pattern are crucial to reduce mortality and improve outcomes in patients with acute LAD occlusions.