Significance of lead aVR in acute coronary syndrome
1Akira Tamura, Department of Cardiology and Clinical Examination, Oita University, Yufu 879-5593, Japan.
Insights
Lead aVR on the 12-lead electrocardiogram (ECG) offers critical insights into acute coronary syndrome (ACS) diagnosis and risk. Analyzing ST-segment shifts and T waves in lead aVR improves understanding of coronary anatomy and patient prognosis.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrocardiography
Background:
- The 12-lead electrocardiogram (ECG) is vital for diagnosing acute coronary syndrome (ACS).
- Lead aVR, often overlooked, is gaining recognition for its diagnostic utility in ACS.
- Recent research highlights the significance of lead aVR in assessing coronary anatomy and patient risk.
Purpose of the Study:
- To emphasize the diagnostic and prognostic value of lead aVR in acute coronary syndrome (ACS).
- To detail the specific ECG findings in lead aVR indicative of myocardial ischemia.
- To encourage greater attention to lead aVR interpretation in clinical practice.
Main Methods:
- Analysis of ST-segment elevation and depression patterns in lead aVR during ACS.
- Correlation of lead aVR findings with coronary angiographic anatomy.
- Evaluation of T wave analysis in lead aVR for prognostic information.
Main Results:
- ST-segment elevation in lead aVR indicates ischemia in the interventricular septum or right ventricular outflow tract.
- ST-segment depression in lead aVR suggests inferolateral or apical region ischemia.
- Lead aVR T wave analysis provides prognostic insights in the general population and post-myocardial infarction patients.
Conclusions:
- Lead aVR analysis provides crucial information for ACS diagnosis, risk stratification, and understanding coronary anatomy.
- Clinicians should increase their focus on lead aVR tracings for comprehensive ECG interpretation.
- Lead aVR findings can guide treatment decisions and improve patient outcomes in ACS.
Abstract:
The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. However, recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS. ST-segment elevation in lead aVR can be caused by (1) transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery; (2) transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery; and (3) reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads. On the other hand, ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions. It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction. Cardiologists should pay more attention to the tracing of lead aVR when interpreting the 12-lead ECG in clinical practice.
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