ECG in LMCA Stenosis

ECG in a person with persistent anginal pain for the past several hours showing significant ST segment depression anterolateral leads along with sinus tachycardia. ST segment elevation is noted in aVR. Such a pattern is consistent with significant left main coronary artery stenosis. Clinical evaluation and X-Ray chest showed features of pulmonary edema. Angiography done after initial stabilization showed severe stenosis of distal left main coronary artery. In addition, there were multiple lesions in all three vessels, making a standard indication for an urgent coronary artery bypass grafting. A similar ECG pattern can also occur in severe proximal triple vessel disease. The previous ECG is shown here for comparison, which shows minimal changes. There is minimal ST segment elevation in aVR as well. This highlights the need for serial ECGs in acute coronary syndrome as initial ECGs may be near normal even in those with severe disease. Classical electrocardiographic pattern in left main coronary artery disease is ST elevation in aVR with extensive ST depression in other leads, most prominent in I, II and V4-V6. ST elevation may be noted in V1, but ST elevation in aVR is more than or equal to that in V1. ST elevation in aVR greater than or equal to that in V1 distinguished left main stenosis from left anterior descending coronary artery stenosis with 81% sensitivity and 80% specificity. ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs