Localising “ Angina related artery ” ( ARA ) in UA/NSTEMI : Can we differentiate culprit artery from lesion ?

Identifying the culprit after a criminal event may be easy for the police.For cadiologists investigating  the crime scne after a coronary event, It is a different story. (Of course, localization of IRA after a STEMI may not be really difficult.) But , when a patient is having UA  and coronary artery shows multiple lesions, we do have real diagnostic issue. The general dictum could be tightest lesion or  complex eccentric lesions with thrombus is likely to be the culprit. This has important therapeutic Impication as we are argued to address the active lesions first. The following study was done in 2009 trying to address this issue soley by ECG features. The conclusion was The following ECG findings were helpful in localizing Angina related artery . ST depression in V3- V5 correlated  with  LAD  angina .Global ST depression was highly correlated with proximal LAD or Left main disease ( 6/6 patients). ST depression in V1 –V3 was associated more commonly with dominant LCX/OM disease. ST depression in 2 ,3 , AVF , or I, AVL  had  no significant correlation with either RCA or LAD  system.However multiple culprit lesions or diffuse inflammatory CAD should always be thought off. One more possibility is , its simply a demand ischemia or micro vascular angina were there is no true epicardial culprit lesion.  A revisit to my 2009 IHJ article. http://indianheartjournal.com/ihj09/nov_dec_09/509-523.html   IDENTIFYING ANGINA RELATED ARTERY (ARA) IN UNSTABLE  ANGINA /...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized Source Type: blogs