De Winter ' s T-waves are Not a Stable ECG condition. Upright T-waves in Posterior OMI are Distinct from de Winter ' s waves.

This was just published in JAMA Internal Medicine:The de Winter Electrocardiogram Pattern Evolving From Hyperacute T WavesIt reminded me that many believe, due to the assertions in the original de Winter ' s article, that de Winter ' s waves are stable.  In fact, the title was "Persistent precordial ‘‘hyperacute’’ T-waves signify proximal left anterior descending artery occlusion. "  The authors based this idea of persistence mostly on their perception, not on a rigorous evaluation involving frequent serial ECGs of all patients with de Winter ' s T-waves. But de Winter ' s waves are not stable. I have seen at least a dozen cases with de Winter ' s T-waves and they have for the most part not been stable but ratherevolving into 1) hyperacute T-waves (without ST depression) or into 2) ST Elevation, or they appearafter initial ST Elevation or hyperacute T-waves.  It is difficult to say if they ALWAYS are in flux because, whenever I see one, I activate the cath lab immediately and the artery is opened without ever recording serial ECGs.Here is one case of a patient I saw.  He was a 30-something with chest pain.Prehospital ECG:Obvious anterolateral STEMI (Proximal LAD occlusion) The cath lab was activated prehospital by the medics.We recorded another ECG:Anterior ST Elevation mostly resolves and now there are primarilyhyperacute T-wavesHigh lateral STE remains30 minutes later, just before arrival of the cath team, we recorded thi...
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