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Post-It Pearls

Post-It Pearls

The Unsung De Winter T-wave

Lin, Michelle MD

doi: 10.1097/01.EEM.0000800536.92201.41
    De Winter T-wave, ECG, LAD occlusion

    The De Winter T-wave is an often-underappreciated ECG finding highly suggestive of an acute LAD occlusion. It has been proposed as a STEMI equivalent when seen in the precordial leads.

    This finding suggests an occlusive myocardial infarction, which would benefit from emergent percutaneous coronary intervention. Its characteristics include:

    • Upsloping ST segment depression greater than1 mm at the J-point in the precordial leads
    • Tall, prominent, symmetrical T-waves in the precordial leads
    • Often with subtle reciprocal ST elevation in lead aVR

    Dr. Linis the founder, CEO, and editor-in-chief of Academic Life in Emergency Medicine ( and a professor of emergency medicine at the University of California San Francisco with interests in health professions education and digital scholarship. Follow her on Instagram@MichelleLinMDand on Twitter@M_Lin.

    Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
    • Jerry W. Jones, MD 10:02:22 AMDr. Lin, Thanks for reminding everyone of this dangerous but too often overlooked ECG finding.