De Winter T waves

Ischaemia

Recognition

  • Upsloping ST depression >1 mm at J-point V1–V6
  • Tall symmetric T waves in same leads
  • Slight ST elevation in aVR

Key findings

  • STEMI equivalent — acute proximal LAD occlusion

Clinical importance

  • Persistent (not evolving to ST↑)

Management pearls

  • Treat as STEMI — activate cath lab for PPCI
  • DAPT + heparin
WardRound

WardRound

Clinical Decisions in Seconds