ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
• Electrocardiogram (ECG) findings of ST-elevation in lead aVR with diffuse ST-segment depression have been historically considered equivalent to ST-elevation myocardial infarction (STEMI) involving the left main or proximal left anterior descending coronary artery.

Purpose of the Study:

• To report a case of isolated left main coronary artery stenosis presenting with specific ECG findings.
• To discuss the diagnostic and management implications of these ECG findings in the context of acute coronary syndrome.

Main Methods:

• A case presentation of a 33-year-old female with APS and exertional chest pain.
• Emergent cardiac catheterization to evaluate coronary arteries.
• Successful percutaneous coronary intervention (PCI) with stent placement.

Main Results:

• The patient presented with exertional chest pain, ST-elevation in aVR, and diffuse ST-segment depression.
• Cardiac catheterization revealed a critical 99% stenosis in the left main coronary artery.
• The patient underwent successful PCI and was discharged without complications.

Conclusions:

• ECG findings of ST-elevation in aVR with diffuse ST-segment depression warrant urgent evaluation for acute coronary syndrome.
• While historically linked to left main or proximal LAD disease, these ECG patterns may indicate other critical coronary artery pathologies.
• Prompt cardiac catheterization is crucial for diagnosis and timely intervention in such cases.