Medical Minute: Lead AVR in Acute Coronary Syndromes

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September 3, 2014 by dailybolusoflr

By Amanda Crichlow, MD

45 yo M presents with chest pain with the following EKG:


Alley, P. Another Widow Maker. Life in the Fast Lane. http://lifeinthefastlane.com/another-widow-maker/.


Question of the day: does ST elevation in lead AVR have any significance?

In a patient with symptoms of acute coronary syndrome, ST elevation in lead AVR could represent one of the following:
1) left main coronary artery occlusion
2) proximal left anterior descending artery occlusion
3) multivessel disease

Studies have also show that findings in lead AVR can predict patient outcomes:

  • AVR ST segment elevation was the strongest predictor of adverse events in 90 days in NSTEMI patients
  • AVR ST segment elevation was associated with higher rates of in hospital death, recurrent ischemia and heart failure

So this patient should receive urgent coronary catherization

References:
  1. Kurz MC, Mattu, A, Brady WJ. Chapter 78 – Acute Coronary Syndrome. Rosen’s Emergency Medicine – Concepts and Clinical Practice, 8th edition. Saunders, an imprint of Elsevier Inc; 2014.
  2. George A, Arumugham PS, Figueredo VM. AVR – the forgotten lead. Exp Clin Cardiol 2010;15(2):e36-e44.
  3. Alley, P. Another Widow Maker. Life in the Fast Lane. http://lifeinthefastlane.com/another-widow-maker/.

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