ST-Segment Elevation in Lead aVR With Global ST-Segment Depression: Never Neglect Left Main Coronary Artery (LMCA) Occlusion

Abstract

An electrocardiographic pattern consisting of elevated ST segment in lead aVR with global ST-segment depression in multi-leads indicates circumferential subendocardial ischaemia due to mismatch of oxygen supply and demand. This finding of an echocardiogram is strongly suggestive of occlusion of proximal part of left anterior descending part of coronary artery. We describe a patient who presented to us with complaint of chest pain and had ST-segment elevation in lead aVR and global ST-segment depression in multi-leads and was suspected to have occlusion in left anterior descending artery. Patient was taken for early coronary angiography and angioplasty then. It was found that patient had occlusion in proximal part of of left anterior descending part only. Hence, early recognition of the condition and its prognosis can help preventing complications.

Management of Acute Coronary Syndrome with ST Segment Elevation aVR Leads in Hospitals with Limited Facilities

“…Kianpi contained dexamethasone. 6 Laboratory results showed elevated cortisol levels with a morning cortisol level of 21.46 mcg/dL (control 18) and an evening cortisol level of 11.64 mcg/dL (control 10). CT scan showed erosion of the right femur head.…”

“…3 Sadapan aVR sering kurang diperhatikan dalam diagnosis SKA, 5 padahal depresi segmen-ST global pada sadapan anterolateral dan inferior disertai elevasi segmen-ST pada sadapan aVR menunjukkan adanya iskemia subendokardial sirkumferensial/luas yang disebabkan oleh oklusi left main coronary artery (LMCA) atau 3VD. 6 Temuan EKG tersebut memiliki nilai prediktif >75% untuk oklusi LMCA atau 3VD, dan merupakan prediktor kuat mortalitas 30 hari pada infark miokard akut non-elevasi segmen-ST (NSTEMI). 5,6 Gambaran EKG tersebut dapat dijumpai pada 7% sampai 32% pasien SKA.…”

“…6 Temuan EKG tersebut memiliki nilai prediktif >75% untuk oklusi LMCA atau 3VD, dan merupakan prediktor kuat mortalitas 30 hari pada infark miokard akut non-elevasi segmen-ST (NSTEMI). 5,6 Gambaran EKG tersebut dapat dijumpai pada 7% sampai 32% pasien SKA. 7 david.kristianus97@gmail.com PENDAHULUAN Laki-laki yang berhubungan seks dengan lakilaki (LSL) mengacu pada semua laki-laki segala usia yang terlibat hubungan seksual dan/ atau romantis dengan laki-laki lain terlepas dari identitas seksual dan orientasi seksual yang dimilikinya.…”

“…5 Proporsi sifilis di antara LSL tertinggi terdapat pada populasi dengan infeksi HIV dengan persentase >5%. 6 Pada tahun 2015 di Indonesia, infeksi HIV di kalangan LSL meningkat menjadi 25,80% dan di Provinsi Bali, khususnya kota Denpasar, didapatkan sebesar 19,11%. 3 Sifilis dan human immunode ciency virus (HIV) merupakan dua infeksi menular seksual yang cintyapradnyandari@gmail.com rmin Dunia Kedokteran is licensed under a Creative Commons Attribution-NonCommercial 4.0 International Licens Ce e.…”

Lead aVR Should Not Be Neglected

“…It has a high specificity for the left main disease (0.86; P < .001) and is closely associated with in-hospital death rates, recurrent ischemic events, and heart failure, and its absence can nearly exclude a substantial LMCA lesion. The presence of STE in lead aVR that is more prominent than in lead V 1 may distinguish LMCA obstruction from LAD and right coronary artery occlusion . However, the subtle magnitude of STE in both leads aVR and V 1 (Figure, A) makes the differential diagnosis of LMCA and proximal LAD difficult.…”