DeWinter T Waves https://www.ecgguru.com/taxonomy/term/623/all en ECG Teaching Series: ST Elevation M.I. With Atypical DeWinter T waves https://www.ecgguru.com/ecg/ecg-teaching-series-st-elevation-mi-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-teaching-series-st-elevation-mi-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AWMI%20DeWinter%20T%20ECG%203.jpg" width="1800" height="702" alt="" /></a></div><div class="field-item odd"><a href="/ecg/ecg-teaching-series-st-elevation-mi-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AWMI%20DeWinter%20ECG%204.jpg" width="1800" height="701" alt="" /></a></div><div class="field-item even"><a href="/ecg/ecg-teaching-series-st-elevation-mi-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AWMI%20DeWinter%20ECG%205.jpg" width="1800" height="701" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This series shows the evolution of ECG changes in anterior wall M.I. secondary to occlusion of the proximal left anterior descending artery. &nbsp;The patient is an 88-year-old woman with chest pain. &nbsp;She was designated a "cardiac alert" from the field by paramedics. &nbsp;Her proximal LAD was opened and stented in the cath lab. &nbsp;We do not have follow-up information on her.</p><p>The first ECG in the series, titled "12-Lead 3", shows ST elevation at the J point in V1 through V3. &nbsp;In addition, the T waves are "hyperacute" - tall, broad, and asymmetrical. This can be an early, transient sign of myocardial injury. &nbsp;Slight reciprocal depressions are seen in the inferior leads. &nbsp;Lead V4 has a T wave inversion that is out of place with the progression of the T waves in V3 and V5. &nbsp;Lead placement may be to blame. &nbsp;Hyperacute T waves in a patient with chest pain should be taken very seriously.</p><p>The second ECG, titled "12-Lead 4", shows continued elevation at the J point in Leads V1 through V3, with a lessening of T wave amplitude. &nbsp;In addition, Lead aVL is showing some T wave changes. The T wave is biphasic, and may be about to become inverted. &nbsp;This is not an improvement! &nbsp;V1 through V3 show us the anterior-septal wall, and an M.I. here indicates occlusion in the LAD. &nbsp;Leads I and aVL show the high lateral area of the anterior wall, and damage here is an indicator that the occlusion is proximal.</p><p>The third ECG, titled "12-Lead 5", shows a "maturing" of the ST segment elevation. &nbsp;Even though there is some significant artifact, we can see that the ST segment in V1 is coved upward, and the ST segment in V2 is flat. &nbsp;Both shapes are abnormal, and a sign of CAD. &nbsp;The T waves have become less pronounced, but V2 looks as if the T wave may become inverted in the near future. &nbsp;V3 looks improved in this image.</p><p>The patient's clinical symptoms did not improve during these ECG changes. &nbsp;Hyperacute T waves are not a definitive sign of STEMI, but they provide a highly visible warning that may catch attention. &nbsp;They definitely are an indication to run <strong>serial ECGs</strong>, as these paramedics did.</p><p>&nbsp;</p></div></div></div> Sat, 21 Jun 2014 19:23:04 +0000 Dawn 582 at https://www.ecgguru.com