Winter is coming, DE Winter

lets talk about two STEMI equivalents, this post covers De winters, Wellens, hypokalemia, hyperkalemia, to jump to a section look for the BOLDED headers

De Winter T waves

  • Indicates an acute proximal LAD occlusion

  • J point depression of 1-3mm

  • tall wide symmetric T waves

  • present in precordial leads v2-6

  • usually 0.5-1mm elevation aVR


Wellens syndrome

  • indicates acute or chronic proximal LAD stenosis

  • may present after chest pain

  • type A symetric isoelectric t waves in V1-2

  • type B has deep symetric T waves in V1-2

  • T changes maybe all the way to V6

  • typically without ST elevation

  • chest pain is often resolved

  • Do NOT stress test* patient has no collaterals patient requires catheterization!

type A:

type B:


*there are case reports of large anterior MI's after stress tests


  • Lengthened PR interval

  • T flattening/inversion

  • ST depression which can mimic ischemia

  • U waves after inverted T waves making the appearance of prolonged QT

  • Ectopic atrial and ventricular beats

  • Will progress to afib, vtach, vfib, or torsades de pointes


  • prolonged PR

  • shortened QT

  • flattened P waves

  • Wide QRS

  • sharp symmetric peaked T waves

  • can have heart block ventricular arythmias

  • progresses to sinusoidal wave of WRS and peaked T and cardiac arrest