Just now 37 yrs old male pt admitted with complaints of chest pain for past 2 hrs.. ECG FINDINGS? TREATMENT ?



Ecg is showing : Tall hyper acute T waves in lead V2 V3 V4 with ST segment depression in lead V2 V3 V4. We can treat in the line of ACS. Need to do serial ecg monitoring every 15 minutes for first two hours. Mental assurance to the patient. Loading dose of aspirin, clopidogrel and statin. Can add beta blocker and LMWH. Can sedate patient with alprazolam or with haloperidol + promethazine. O2 inhalation if SPO2 falls below 90%. Need to send Trop I after six hours from onset of chest pain.

Hi arnab. very good morning. .so nice answers. ..still more ecg findings I'm expecting. ..Thank you so much for ur prompt reply. ..

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Thank you so much for all the participants and excellent answers and guidance. .. DIAGNOSIS. .CLASSICAL FINDINGS OF DE WINTER T WAVE. .In anterior leads. . STEMI EQUIVALENT. . If we recognised this ecg finding...then we will do PCI or thrombolysis. .but ideal will b PCI. IF under recognised this finding. ..then we treat like CAD .UNSTABLE ANGINA. .then morbidity and mortality will b high.. I saw this pt today early morning 3 am..and diagnosed and treated with INJ. SK ..only available agent in our hospital. . plz see the result... before thrombolysis

Thanks a ton sir for posting such a wonderful ecg.

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Thank you Dr Suresh for wonderful case discussion and congratulations for successful diagnosing and treating this pt. I recently read about this sign and thought to share but u have posted an original case. wonderful job.

Thank you so much for ur appreciation and encouragement sir. ..I have posted already another similar case ..snake bite with MI. .ecg. De winter t waves....Thanks a lot sir. ..

Dear Dr.Suresh it's a DE WINTER SIGN seen in precordial leads...Their is an urgent indication for PRIMARY PCI...Thrombolysis doesn't work in these kind of cases bcoz Their is an LAD occlusion which is Ongoing...may be blocked completely in few hours...It's highly fatal.... Up sloping ST DEPRESSION in V2 to V6 s/o De winters sign...

Thanks Dr. sandeep for ur expert opinion. ......In our medical college pci not available sir..

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leads v3-4 showing upsloping ST depression with symmetrically peaked t waves. called de winters T waves. highly specific for acute LAD occlusion. de winters ECG pattern is an anterior STEMI equivalent. key diagnostic features include ST depression & peaked T waves in precordial leads. . this is without any obvious ST elevation. either thrombolysis or Primary PTCA. do echo , routine investigations & cardiac enzymes

upsloping ST depression in precordial leads should be more than 1mm at J point

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After thrombolysis ecg. ..

Suresh sir, many many hearty congratulations for saving one life. It means a lot. You have done right thing at right time. Thank you sir. It's a great satisfaction indeed when our hard work and dedication pays off.

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ST depression in v3 v4 posterior wall MI?

Nice DD sir. Thank you

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yes , thrombolisation really works in it. thanks suresh sir for posting this nice ECG /case.keep on posting like this. it helps in improving & updating ourselves.

in fact these kind of ECG easily go untoticed & under diagnosed, leading to increased mortality

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picture from Internet source.

Good diagram

DeWinter's T wave in v2 to v5 rush to cath lad occultation

Nice answer sir. Thank you so much
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