DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS OF ST-SEGMENT ELEVATION IN LEAD aVR OF 12 LEAD ECG DURING CHEST PAIN

Naveed Akhtar, Uzma Bashir, Waqas Ahmed, Syed Mumtaz Ali Shah

Abstract


‘aVR’ is usually not the preferred lead to diagnose myocardial infarction in clinical settings, it is rather a neglected lead in this context. We describe the case of a 44 year old male who presented with short duration chest pain and ST segment elevation in lead ‘aVR’. His left heart catheterization showed left main stem equivalent disease and totally occluded right coronary artery. Patient underwent emergency coronary artery bypass-grafting with favorable outcome. This case highlights the significance of ST segment elevation in lead aVR during chest pain both in diagnosis and management of patients with acute coronary syndrome.

Keywords: ST segment elevation, aVR, left main stem occlusion.


Full Text:

PDF

References


Braunwald E, Zipes D, Libby P, Heart Disease: A Textbook of Cardiovascular Medicine. 6th Ed. St Louis:Mosby;2001.

Dassen W, Gorgles A, Mulleneers R, Karthaus V, Els HV, Talmon J. Development of ECG criteria to diagnose the number of narrowed coronary arteries in rest angina using self-learning techniques. J Electrocardiol 1994;27 Suppl:156-60.

Hori T, Kurosawa T, Yoshida M, Yamazoe M, Aizawa Y, Izumi T. Factors predicting mortality in patients after myocardial infarction caused by left main stem coronary artery occlusion. Significance of ST segment elevation in both aVR and aVL leads. Japanese Heart Journal 2000;41:571-81.

Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hina K, et al. Prediction of acute left main coronary artery obstruction by 12 lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V. J Am Coll Cardiol 2001;38(5):1348-54.

Barrabes JA, Figueras J, Moure C, Cortadellas J, Soler-Soler J. Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction. Circulation 2003;108(7): 814-9.

Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF et al, 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. J Am Coll Cardiol 1999;36:890-911

Rajdeep S. Gaitonde DO, Sharma N, Ali-Hassan S, Miller JM, Jayachandran JV, Kalaria VG. Prediction of significant left main coronary artery stenosis by the 12-lead electrocardiogram in patients with rest angina pectoris and the withholding of clopidogrel therapy. The American Journal of Cardiology 2003; 92(7): 846-8.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]