The Neglected Lead on Electrocardiogram: T Wave Inversion in Lead aVL, Nonspecific Finding or a Sign for Left Anterior Descending Artery Lesion?

Hassen, Getaw Worku; Costea, Ana; Smith, Tennyson; Carrazco, Claire; Hussein, Hafiz; Soroori-Rad, Bahareh; Vaidian, Sonia; Seashore, Justin; Alderwish, Edris; Sun, Wei; Chen, Alice; Simmons, Bonnie; Usmani, Shakeel; Kalantari, Hossein; Fernaine, George

doi:10.1016/j.jemermed.2013.08.079

Cited by 7 publications

(15 citation statements)

References 21 publications

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“…T wave changes in lead aVL might be considered nonsignificant by most physicians; however, a limited number of studies have shown the importance of T wave changes in recognition of right ventricular involvement in inferior wall MI [ 30 , 31 ] and sign of mid-LAD lesion [ 10 , 11 , 32 ]. Farhan et al found 14.1% of the ECGs they reviewed had TWI in lead aVL.…”

Section: Discussionmentioning

confidence: 99%

“…The results of a recent study by our group indicated that TWI was associated with mid-LAD lesion with a sensitivity of 87.8 and positive predictive value of 81% for significant mid-LAD lesion (50% and above on coronary angiography) when evaluating angiograms for ST elevation MIs (STEMI). Patients who underwent coronary angiography for other reasons demonstrated a sensitivity of 65.2%, PPV of 83.3%, and specificity of 66.7 for significant mid-LAD lesion (70% and above on coronary angiography) [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report

Hassen

Costea

Carrazco

et al. 2015

Emergency Medicine International

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Background. Computerized electrocardiogram (ECG) analysis has been of tremendous help for noncardiologists, but can we rely on it? The importance of ST depression and T wave inversions in lead aVL has not been emphasized and not well recognized across all specialties. Objective. This study's goal was to analyze if there is a discrepancy of interpretation by physicians from different specialties and a computer-generated ECG reading in regard to a TWI in lead aVL. Methods. In this multidisciplinary prospective study, a single ECG with isolated TWI in lead aVL that was interpreted by the computer as normal was given to all participants to interpret in writing. The readings by all physicians were compared by level of education and by specialty to one another and to the computer interpretation. Results. A total of 191 physicians participated in the study. Of the 191 physicians 48 (25.1%) identified and 143 (74.9%) did not identify the isolated TWI in lead aVL. Conclusion. Our study demonstrated that 74.9% did not recognize the abnormality. New and subtle ECG findings should be emphasized in their training so as not to miss significant findings that could cause morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report

Hassen

Costea

Carrazco

et al. 2015

Emergency Medicine International

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“…The only finding in ECG for acute MI might be ST-depression 2. Moreover, T-wave inversion in lead aVL might be the only sign of a left anterior descending artery (LAD) lesion 3. The purpose of this case is to emphasise the importance of isolated ST changes in lead aVL and to point out the benefits of encouraging emergency physicians to use early invasive intervention for these patients.…”

Section: Introductionmentioning

confidence: 94%

Electrocardiographic clue for a mid-LAD lesion

Doğanay

Onur

et al. 2016

BMJ Case Reports

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ECG is still the first diagnostic tool for coronary artery disease. It is possible to predict the localisation of affected vessel(s) through ST and T changes on ECG. Sometimes, reciprocal changes may be the only marker of acute myocardial ischaemia, as single T-wave inversion in lead aVL may represent a coronary artery lesion in the left anterior descending (LAD). A 49-year-old woman presented to the emergency department, with left-sided chest pain. Her initial ECG showed no ischaemic changes. On the third hour ECG there was T-wave inversion in leads aVL and V2, and troponin turned positive. Coronary angiography showed 90% mid-LAD occlusion. The importance of this case is that patients with ischaemic chest pain should be followed with serial ECG. Also, emergency physicians should be alert to identify new changes on ECG, as isolated T-wave inversion in lead aVL can be the only finding to take the patient into the catheterisation laboratory.

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“…The management of proximal obstructive CAD is more important as larger myocardial areas are supplied downstream from the stenosis. The left anterior descending coronary artery (LAD) which supplies 40% to 50% of total left ventricular (LV) myocardium and may result in major ischemic damage, for this reason early detection of LAD stenosis has a vital role for patients with CAD to avoid damaging a large functional part of LV [9][10][11][12]. We aimed to study the diagnostic value of electrocardiographic ST-T wave changes in lead aVL in prediction of site of coronary artery stenosis in patients with chronic stable angina.…”

Section: Introductionmentioning

confidence: 99%

Value of electrocardiographic T wave inversion in lead aVL in prediction of Mid Left Anterior Descending Stenosis in patients with stable Coronary Artery disease

Magdy¹

2017

J Cardiol Cardiovasc Med

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The Neglected Lead on Electrocardiogram: T Wave Inversion in Lead aVL, Nonspecific Finding or a Sign for Left Anterior Descending Artery Lesion?

Cited by 7 publications

References 21 publications

Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report

Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report

Electrocardiographic clue for a mid-LAD lesion

Value of electrocardiographic T wave inversion in lead aVL in prediction of Mid Left Anterior Descending Stenosis in patients with stable Coronary Artery disease

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