QUESTIONS

  1. What are De WInter’s T-waves
  2. What are the EKG findings in a posterior MI?
  3. What should the EKG below make you worry about?T-V1
  4. What should the EKG below make you worry about?

Wellen's

 

ANSWERS

  1. De Winter’s T-waves:
  • This is a STEMI equivalent according to the 2013 STEMI guidelines
  • Precordial leads: V1-V5
  • Upsloping ST depression >1 mm
  • Tall/peaked T waves
  • Associated with proximal LAD occlusion

De Winter

 

2. Posterior MI: This is a STEMI equivalent according to the 2013 STEMI guidelines

  • ST depression >0.5 mm in leads V1-V3 with upright T waves
  • May develop tall R waves in V1-V3
  • ST elevation in posterior leads: V7- V9,

Posterior MI

 

3. T-V1: can be a marker of ACS

  • A large upright T-wave in V1 can be suggestive of acute ischemia,
  • This is especially true if it is new

T-V1

4. Wellens: often a marker of ACS

  • Biphasic  or deep T waves in V2-V3 (DDx = PE) usually while patient pain free (it represents cardiac reperfusion)
  • May look nonspecific, but signify severe proximal LAD stenosis
  • Do not do a stress test because it is too risky. Go straight to cath instead.

Wellen's

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