Importance of lead aVR

Importance of lead aVR Lead aVR was often ignored as all the waves are inverted in aVR in contrast to other leads. Lead aVR is thought to point to the cavity of the heart. It has been called the neglected lead [1] and the forgotten lead [2]. Lead aVR came into limelight with the identification of the significance of ST elevation in the lead indicating left main coronary artery disease. Classical electrocardiographic pattern in left main coronary artery disease is ST segment elevation in aVR with extensive ST depression in other leads, most prominent in I, II and V4-V6 [3]. ST elevation in aVR can also occur in proximal left anterior descending coronary artery disease. ST segment elevation in aVR greater than or equal to that in V1 distinguished left main stenosis from left anterior descending coronary artery (LAD) stenosis with 81% sensitivity, 80% specificity. ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due to transmural ischemia of the basal part of the septum [4]. Injury current of basal part of septum is directed towards right shoulder and aVR. ST segment elevation in aVR noted in left main disease is also likely due to the same mechanism as flow to first septal is blocked in this case as well. Mortality was more frequently observed in left main obstruction patients with higher degree of ST elevation in aVR [5]. ECG in left main coronary artery stenosis ECG in a person with persistent anginal pain for the past several hours ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: ECG / Electrophysiology Source Type: blogs