Electrocardiogram Diagnosis: ST-Depression With T Wave Inversion in Lead Augmented Vector Left as Harbinger of
Grace V Heringer1,2, Cole J Florio1,3, Aidan R Campbell1
1Kaiser Permanente Clinical Research on Emergency Services & Treatments (CREST) Network, Pleasanton, CA, USA.
The Permanente Journal
|September 30, 2025
Summary
Reciprocal changes on electrocardiograms (ECGs), particularly in lead aVL, can signal early inferior ST-segment elevation myocardial infarction (STEMI). Prompt intervention is crucial for optimal outcomes in acute coronary syndrome.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Acute coronary syndrome (ACS) requires rapid diagnosis and intervention.
- Electrocardiograms (ECGs) are critical for identifying ST-segment elevation myocardial infarction (STEMI).
- Inferior STEMI diagnosis can be challenging, sometimes presenting with subtle ECG findings.
Purpose of the Study:
- To highlight the diagnostic utility of reciprocal changes in lead aVL for inferior STEMI.
- To emphasize the importance of serial ECG monitoring in suspected ACS.
- To illustrate the benefits of timely percutaneous coronary intervention (PCI) in STEMI.
Main Methods:
- Case report of a 53-year-old male presenting with chest discomfort.
- Utilized serial 12-lead ECGs, including prehospital and emergency department recordings.
- Performed coronary angiography and successful percutaneous coronary intervention (PCI).
Main Results:
- Initial ECG showed ST depression and T wave inversion in aVL; subsequent ECGs revealed inferior STEMI.
- Coronary angiography identified critical stenosis and thrombotic occlusion in the right coronary artery (RCA).
- Successful PCI restored TIMI grade 3 flow, leading to patient discharge on hospital day 3.
Conclusions:
- Reciprocal ST depression in lead aVL is a significant early indicator of inferior STEMI.
- Serial ECGs are essential for detecting evolving myocardial infarction.
- Timely PCI significantly improves outcomes for patients with acute STEMI.
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