Electrocardiographic applications of lead aVR

A descriptive analysis of patients with an emergency department diagnosis of acute pericarditis

“…Typical ST elevation and PR depression were the most common findings although were not universal. PR segment elevation in aVR was seen in 27.4% (95% CI 21.0% to 34.6%) of cases and has been described previously as a ubiquitous characteristic of acute pericarditis 13 14. Of the three patients with a low voltage QRS suggesting pericardial effusion, none required emergent drainage.…”

“…Recognition of the ECG findings in pericarditis is important in the assessment of acute chest pain and typical ECG changes are frequently described 13 14. The significance of these changes in assisting diagnosis in the ED has not been described previously.…”

Acute Myoperidarditis with Focal ECG Findings Mimicking Acute Myocardial Infarction

“…The first stage, which is commonly encountered in the ED and B. C. Nisbet and M. Breyer most characteristic of pericarditis, occurs in the first hours to days of symptoms and is characterized by diffuse ST-segment elevation (almost always observed in V4 -V6 and lead II) with reciprocal changes in aVR and V1, concave upwards morphology of the ST-segment and PR-segment deflection opposite to P-wave polarity (3,4). PR-segment changes, which occur in about 80% of cases, are typically seen in stage 1 or stage 2, and are most commonly represented by PR depression in lead II and PR-segment elevation in lead aVR (4,5). Our patient's next ECG (Figure 3), taken 3 days later, highlights the second stage in acute pericarditis, typically occurring 1-3 weeks after presentation and demonstrating decreased amplitude, ST-segment normalization, and Twave flattening (3,4).…”

Transient ST-segment elevation in lead aVR associated with tako-tsubo cardiomyopathy

“…Lead aVR ST-segment elevation may also be found in other clinical conditions, including acute proximal occlusion of the left anterior descending coronary artery, acute pulmonary embolism, preexcitation syndrome-related narrow complex tachycardia, and severe, prolonged arterial hypotension [1,2,7].…”