Diffuse ST-Segment Depression with ST-Segment Elevation in Lead aVR in 12-Lead Electrocardiography May Indicate
Tien-Chi Huang1, Meng-Kuang Lee1, Shin-Jing Lin1
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Insights
Electrocardiography findings of diffuse ST depression with ST elevation in lead aVR in a patient with severe aortic stenosis were initially concerning for coronary artery disease but ultimately indicated a different critical condition. This case highlights the diagnostic challenges and potential for misinterpretation of these specific ECG changes.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
Background:
- Diffuse ST depression with ST elevation in lead aVR is a concerning ECG pattern.
- This pattern can suggest critical coronary artery disease, pulmonary embolism, or takotsubo cardiomyopathy.
- Severe aortic stenosis presents a complex clinical scenario for interpreting ECG findings.
Unlabelled:
Diffuse ST-segment depression with ST-segment elevation in the lead augmented vector right (aVR) in 12-lead electrocardiography may indicate the possibility of coronary artery disease involving the left main coronary artery or proximal left anterior descending artery, pulmonary embolism or takotsubo cardiomyopathy. We report a 69-year-old female with severe aortic stenosis, who had similar electrocardiographic findings which indicated ischemic change and led to cardiogenic shock and ventricular tachycardia. Intubation and insertion of an intra- aortic balloon pump (IABP) were performed and the result of coronary angiography showed only less than 40% stenosis. Her blood pressure gradually stabilized, and diffuse ST-segment depression or ST-segment elevation in lead aVR was not noted in the 12-lead electrocardiography. However, we removed the IABP and after 6 hours, sudden profound shock refractory to combined vasopressors occurred. Electrocardiography again showed ST- segment elevation in aVR with and diffuse ST-segment depression. After several episodes of ventricular tachycardia, cardiopulmonary resuscitation was not successful and the patient expired in our hospital.
Key Words:
Diffuse ST depression; Severe aortic stenosis; ST elevation in aVR.
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