Hyperacute T Waves

Hyperacute T waves are seen early in occlusive myocardial infarction and are characterized by a broad base and rounded top; they are large in amplitude when compared to the QRS complex. In 2008, deWinter described a pattern of ST depressions and hyperacute, or “rocket” T waves in the precordial leads that indicated proximal left anterior descending occlusion. The pattern was initially described as static but has since been described as dynamic, too. It is believed to occur in about 2% of anterior myocardial infarctions. deWinter T waves have been described in myocarditis where the phenomenon is consistent with general myocardial injury rather than coronary occlusion.



  1. de Winter RJ, Verouden NJW, Wellens HJJ, Wilde AAM. A New ECG Sign of Proximal LAD Occlusion. New England Journal of Medicine. 2008;359(19):2071-2073.
  2. 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. American Journal of Emergency Medicine. 2014;32(3):287.e5-287.e8.