This is really good Prehospital, ED, and Cardiology care. Inferior de Winter ' s T-waves.

A 50-something y.o. male with history of previous acute MI and stent was shoveling snow.  Shortly thereafter he had the onset of tight chest pain across the front of his chest, without radiation, but associated with diaphoresis and nausea without vomiting. It felt similar to his prior heart attack 9 years ago. He called EMS immediately. Here is his first prehospital ECG: What do you see?There is ST depression maximal in V3, and also in inferior leads.  There is minimal T-wave inversion in aVL, by itself a soft sign of inferior MI.  Are the T-waves large?  Does this inferior ST depression with large T-waves representinferior de Winter ' s waves?  So this is an inferior-posterior OMI, very subtle.Inferior De Winter ' s waves have been reported before by Sunil KarnaThe medics immediately recognized ischemic ST depression. They gave aspirin and sublingual nitroglycerine.  The pain resolved and they recorded another ECG:The ST depression is gone.  In fact, one might not have recognized those hyperacute T-waves on the initial ECG until comparing with the next resolved ECG, where the inferior T-waves are now much smaller than they were.  The T-wave inversion in aVL is also gone.Medics recognized that this was an acute MI and alerted the ED, even though they did not activate the cath lab.Thus, when the patient arrived, cardiology had been notified and was in the ED when the patient arrived (it was a weekday during ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs