MI

Question 1

De Winter T waves

Answer 1

STEMI equilvalent
Case series in 2008
2% of acute proximal LAD occlusions

Features

• Tall, peaked, symmetric T waves in precordial leads
• Upsloping STD >1mm in precordial leads
• STE 0.5-1mm in aVR

Question 2

Wellens’ syndrome

Answer 2

STEMI equilvalent
in 1982, subset of unstable angina patients
Critical stenosis of proximal LAD 
At risk of extensive anterior wall MI
Findings can be transient

2 types
Type A (25%)
- Biphasic T wave, usu in V2/3
Type B (75%)
- Deep symmetrical TWI, usu in V2/3

Criteria

• Characteristic T wave changes
• Hx of angina
• normal / minimally elevated TnI
• ECG without Q waves / sig. STE; with normal precordial R wave progression

Cocaine -> Pseudo-Wellens due to vasospasm

Question 3

STEMI definition

Answer 3

• ≥1 mm new STE at the J-point in two contiguous leads other than V2-V3
• V2-V3:
  ≥2 mm in men ≥40 years
  ≥2.5 mm in men <40 years,
  ≥1.5 mm in women regardless of age