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Evolution of our understanding of the aVR sign

Michael A Gibbs1, Jacob B Leedekerken1, Laszlo Littmann2

  • 1Department of Emergency Medicine, Atrium Health - Carolinas Medical Center, Charlotte, NC, USA.

Journal of Electrocardiology
|August 12, 2019
PubMed

Insights

The electrocardiographic "aVR sign" in acute coronary syndrome (ACS) indicates high risk, potentially signifying left main disease or STEMI equivalent. Careful interpretation is crucial to avoid under- or over-treatment.

Area of Science:

  • Cardiology
  • Electrocardiography

Background:

  • The "aVR sign" (ST depression and ST elevation in lead aVR) on ECG is linked to severe coronary artery disease and mortality in acute coronary syndrome (ACS).
  • Current guidelines consider the aVR sign an ST-elevation myocardial infarction (STEMI) equivalent, warranting urgent intervention.

Purpose of the Study:

  • To review the historical context and evolving understanding of the aVR sign in ECG.
  • To illustrate the risks of both under- and over-interpreting the aVR sign using clinical cases.

Main Methods:

  • Literature review of the aVR sign in ACS.
  • Analysis of two illustrative patient cases.

Main Results:

  • The aVR sign is associated with high-risk conditions, including left main coronary artery stenosis and diffuse coronary artery disease.
  • The specificity of the aVR sign for left main disease is debated due to its association with other critical conditions.

Conclusions:

  • The aVR sign is a critical ECG finding in ACS, requiring nuanced interpretation.
  • Accurate assessment of the aVR sign is vital to guide appropriate and timely cardiac catheterization and reperfusion therapy.

Keywords:
Acute coronary syndromeAortic dissectionElectrocardiogramLeft main coronary artery stenosisNon-ST-elevation ACSPulmonary embolismaVR sign

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