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

被引:4
作者
Kabra, Ruchita [1 ]
Acharya, Sourya [1 ]
Kamat, Sandeep [2 ]
Kumar, Sunil [1 ]
机构
[1] Datta Meghe Inst Med Sci, Dept Med, Jawaharlal Nehru Med Coll, Wardha, India
[2] Topiwala Natl Med Coll & BYL Nair Charitable Hosp, Cardiol, Mumbai, India
关键词
global; lead avr; electrocardiogram; mismatch oxygen supply; circumferential subendocardial ischaemia; INTERNATIONAL-SOCIETY; ELECTROCARDIOGRAPHY; DISEASE;
D O I
10.7759/cureus.26522
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
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页数:4
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共 8 条
[1]   Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography [J].
Gorgels, APM ;
Engelen, DJM ;
Wellens, HJJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 38 (05) :1355-1356
[2]   Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? [J].
Knotts, Robert J. ;
Wilson, James M. ;
Kim, Edward ;
Huang, Henry D. ;
Birnbaum, Yochai .
JOURNAL OF ELECTROCARDIOLOGY, 2013, 46 (03) :240-248
[3]   Electrocardiographic Presentation of Left Main Disease in Patients Undergoing Urgent or Emergent Coronary Artery Bypass Grafting [J].
Nikus, Kjell ;
Jarvinen, Otso ;
Sclarovsky, Samuel ;
Huhtala, Heini ;
Tarkka, Matti ;
Eskola, Markku .
POSTGRADUATE MEDICINE, 2011, 123 (02) :42-48
[4]   Report of the third International Society for Holter and Noninvasive Electrocardiology working group on improved electrocardiographic criteria for acute and chronic ischemic heart disease-Lund, Sweden: June 2010 [J].
Nikus, Kjell ;
Pahlm, Olle ;
Wagner, Galen ;
Terkelsen, Christian Juhl ;
Gettes, Leonard .
JOURNAL OF ELECTROCARDIOLOGY, 2011, 44 (01) :84-86
[5]   Electrocardiographic presentations of acute total occlusion of the left main coronary artery [J].
Nikus, Kjell C. .
JOURNAL OF ELECTROCARDIOLOGY, 2012, 45 (05) :491-493
[6]   Manifestation of left main coronary artery stenosis is diffuse ST depression in inferior and precordial leads on ECG [J].
Sclarovsky, S ;
Kjell, N ;
Birnbaum, Y .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (03) :575-576
[7]   AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part VI: Acute Ischemia/Infarction A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology [J].
Wagner, Galen S. ;
Macfarlane, Peter ;
Wellens, Hein ;
Josephson, Mark ;
Gorgels, Anton ;
Mirvis, David M. ;
Pahlm, Olle ;
Surawicz, Borys ;
Kligfield, Paul ;
Childers, Rory ;
Gettes, Leonard S. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (11) :1003-1011
[8]   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 V1 [J].
Yamaji, H ;
Iwasaki, K ;
Kusachi, S ;
Murakami, T ;
Hirami, R ;
Hamamoto, H ;
Hina, K ;
Kita, T ;
Sakakibara, N ;
Tsuji, T .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 38 (05) :1348-1354