De Winter T waves
Also calledde Winter pattern · de Winter ST-T complex · de Winter sign · dewinter T waves · de Winter T waves
Definition
An ST-elevation MI equivalent pattern consisting of upsloping ST depression of at least 1 mm at the J point in the precordial leads (1 to 3 mm across V1 to V6 in the original description), continuing into tall, prominent, symmetric T waves, without ST elevation in the precordial leads. It is often accompanied by mild ST elevation in aVR and signifies acute occlusion of the proximal left anterior descending artery. The pattern was static in the original series, but later reports show it can change into, or follow, classic ST elevation.
Sources
- Verouden NJ, Koch KT, Peters RJ, et al. Persistent precordial "hyperacute" T-waves signify proximal left anterior descending artery occlusion. Heart. 2009;95(20):1701-1706. doi.org/10.1136/hrt.2009.174557
- Elmenyar E, Abbara MA, Al-Ghoul Z, et al. Phenomenon of "de Winter" pattern, sign, or syndrome: a systematic scoping review and data analysis. World J Cardiol. 2026;18(2):114561. doi.org/10.4330/wjc.v18.i2.114561
- Zhan ZQ, Li Y, Han LH, Nikus KC, Birnbaum Y, Baranchuk A. The de Winter ECG pattern: distribution and morphology of ST depression. Ann Noninvasive Electrocardiol. 2020;25(5):e12783. doi.org/10.1111/anec.12783
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138(20):e618-e651. doi.org/10.1161/CIR.0000000000000617
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.