Acute MI de Winters

A 26 years old male comes to ER with complaints of severe sub sternal chest pain, radiating to jaw and left arm, from last one hour. Associated increased shortness of breath and perspiration. Patient does not have HTN or Diabetes. ECG done in ER shows characteristic changes. Diagnosis ?

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de Winters T wave presentation, equivalent of Acute STEMI. The de Winter pattern is seen in~2% of acute LAD occlusionsandis under-recognised by clinicians. Diagnostic criteria : 1. Tall, prominent, symmetric T waves in the precordial leads. 2. Upsloping ST segment depression >1mm at the J-point in the precordial leads. 3. Absence of ST elevation in the precordial leads. 4. ST segment elevation (0.5mm-1mm) in aVRNormal STEMI morphology may precede or follow the deWinter pattern.

Ecg showing ST depression in 1 avl V2 to v6 .. with upright T WAVES and st elevation in avr .. s/o De Winter s t WAVE .. It's STEMI equivalent.. signifies acute LAD occlusion

Agree Dr. Vora . Need immediate PCI or thrombolysis, as it evolved to ant wall MI soon.
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Sinus rhythm,st depression in limb leads with St segment elevation in lead AVR,st segment depression in lead v2to v6 with upslope symmetrical hyperacute T wave suggestive of De winter T wave equivalent to mi. Needs cardiac enzymes, Lipid profile,sr electrolyts,urgent thrombolysis.

Young man of 26 years old. The ecg is suggestive of hyperacute phase of anterolateral infarction. It may be just angina pectoris. But a 26 years old youngster developing IHD, we have to explore hereditary factors also. A case study says " a short stem of left coronary of less than 1.5 cm long is likely to run families causing IHD"

He has familial hypercholesterolemia.
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Anterior and inferior wall ischaemia with WPW syndrome.

tall t wave in v2 v3 with st depression in v2 v3 ?true post wall mi

antero lateral mi

Dewinter's T wave in v2 to v6 AWMI

Sorry for the typos.

Ant.&lat.wall ischemia

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