aVR: The forgotten lead in acute coronary syndrome: A case series
Sanya Chhikara1, Rajat Datta2, Ningthoujam Rishikanta3
1University of Minnesota Medical Center, 2709 Delaware St SE, Minneapolis, MN, USA.
Insights
ST elevation in lead aVR (STE aVR) indicates poor prognosis in acute coronary syndromes. Patients with STE aVR face higher risks of heart failure, instability, kidney injury, and mortality, necessitating early revascularization.
Area of Science:
- Cardiology
- Electrocardiography
- Acute Coronary Syndromes
Background:
- Lead aVR is often overlooked in electrocardiogram (ECG) interpretation.
- It holds significant diagnostic and prognostic value in acute coronary syndromes (ACS).
Observation:
- This study presents four cases of ACS with ST-elevation in lead aVR (STE aVR).
- These cases involved critical stenosis in coronary vessels.
Findings:
- STE aVR is associated with a poor prognosis in ACS patients.
- Associated risks include heart failure, hemodynamic instability, acute kidney injury, and increased mortality due to extensive myocardial infarction.
Implications:
- Early recognition of STE aVR is crucial for risk stratification.
- Prompt revascularization strategies are warranted for patients presenting with STE aVR to improve outcomes.
Abstract:
Lead aVR is often considered as a neglected lead or forgotten lead owing to its reciprocal location to the lateral leads. However, it has diagnostic and prognostic importance in cases of acute coronary syndromes. We present a series of four cases of acute coronary syndrome with ST elevation (STE) in aVR and critical stenosis in coronary vessels. Patients with STE in aVR have a poor prognosis with increased morbidity not limited to increased chances of heart failure at presentation, greater hemodynamic instability, and in-hospital acute kidney injury, as well as increased mortality due to large infarction areas. Thus, early revascularization is warranted in such cases.
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