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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

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Published on: December 28, 2012

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

Bruce M Lo¹, Megyn K Christensen², Katherine E Schaffer²

¹Sentara Norfolk General Hospital/Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia.

Clinical Practice and Cases in Emergency Medicine

|February 4, 2025

Summary

A patient with antiphospholipid syndrome experienced exertional chest pain due to severe left main coronary artery stenosis. Urgent catheterization and stenting successfully treated this acute coronary syndrome presentation.

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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.