ST-segment elevation in lead augmented vector right may also be caused by diffuse left main coronary artery vasospasm
Hamza Duygu1, Oguz Yavuzgil, Umit Erturk
1Department of Cardiology, Ege University, Izmir, Turkey. hamzakard@yahoo.com
Clinical Cardiology
|April 12, 2008
Summary
ST-segment elevation in lead aVR can indicate left main coronary artery obstruction. This case highlights diffuse left main coronary artery spasm as a cause of ST-segment elevation in aVR, expanding diagnostic considerations for acute coronary syndrome.
Area of Science:
- Cardiology
- Clinical Electrocardiography
- Emergency Medicine
Background:
- ST-segment deviation in the augmented vector right (aVR) lead is a recognized indicator for evaluating acute coronary syndrome (ACS).
- ST-segment elevation in aVR typically suggests proximal left coronary artery obstruction, often due to fixed stenosis of the left main coronary artery (LMCA).
Observation:
- A case of ST-segment elevation in the aVR lead was observed in a patient with clinically suspected acute coronary syndrome.
- This specific electrocardiographic finding prompted further investigation into the underlying cause of potential LMCA obstruction.
Findings:
- The study reports the first known case of ST-segment elevation in lead aVR attributed to diffuse left main coronary artery (LMCA) spasm.
- This finding challenges the conventional understanding that LMCA obstruction in aVR elevation is solely due to fixed stenosis.
Implications:
- This case expands the differential diagnosis for ST-segment elevation in aVR during acute coronary syndrome.
- Recognizing LMCA spasm as a cause is crucial for timely and appropriate management, potentially altering treatment strategies beyond typical percutaneous coronary intervention for stenosis.
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