Submitted by Dawn on Sun, 02/19/2012 - 03:07
This ECG is from a patient with chest pain. We have no other information about the patient. The rythm is atrial fibrillation with a ventricular response of about 113/min. There is ST elevation in aVR, with ST depression in all other leads, except V1 and aVL. V1 is probably caught between showing us ST elevation from the base of the heart (like aVR) and ST depression from the anterior wall (like V2). Therefore, the ST is flat. aVL is often elevated in proximal LCA lesions, as well.
This pattern in a person with chest pain is associated with severe acute coronary syndrome (ACS), often with conditions that cause cardiogenic shock. Proximal left coronary artery obstruction or severe triple vessle disease are likely.
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In this ECG, aVR shows ST
In this ECG, aVR shows ST segment elevation, with widespread ST depression. For years, aVR was virtually ignored in the literature, and considered to be only a reciprocal view of the lateral inferior wall. Now, there is convincing evidence of its usefulness in discovering proximal left coronary artery occlusion and severe triple vessel disease. ST elevation in aVR can be a reliable sign of ischemia of the basal part of the heart and the proximal IV septum.
Many people with complete occlusion of the left main do not survive. When there is some diminished blood flow through the blocked area in the proximal LAD or left main, this pattern may appear. Look for ST elevation in aVR greater than or equal to 1 mm, ST elevation in aVR greater than the ST elevation in V1, and widespread ST depression. This patient was treated with emergent coronary artery bypass.
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Dawn Altman, Admin