As if there weren’t enough morphologies and subtleties in the EKG, here is another ekg finding that you should be aware of…

de Winter T-waves

  • 1-3 mm ST-depression upsloping at the J-point in the mid precordial leads leading to tall symmetric T-waves
  • No large studies on the topic
  • Several small case series show correlation with acute LAD occlusion

De Winter


de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. A new ECG sign of proximal LAD occlusion. N Engl J Med. 2008 Nov 6;359(19):2071-3

Rokos IC, French WJ, Mattu A, et al. Appropriate cardiac cath lab activation: optimizing electrocardiogram interpretation and clinical decision-making for acute ST-elevation myocardial infarction. Am Heart J. 2010 Dec;160(6):995-1003

For a much more thorough look into this topic check out this paper…

Goebel M, Bledsoe J, Orford JL, Mattu A, Brady WJ. A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr. Am J Emerg Med 2014;32(3):287.e5–8.

Credit to Dr. Mattu’s ekg site for highlighting this interesting ekg finding