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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Time is muscle, context is key: Re-evaluating the urgency of aVR ST elevation.

Federico Paolini¹, Leonardo Brugiatelli¹, Alessandro D'Alfonso²

¹Cardiology-UTIC, AST Pesaro, Italy.

Journal of Electrocardiology

|May 13, 2026

Summary

The electrocardiogram (ECG) finding of ST elevation in lead aVR with diffuse ST depression can indicate serious cardiac issues. This case highlights its association with type A aortic dissection, not just coronary artery disease.

Keywords:

Acute coronary syndrome Aortic dissection Electrocardiography Global subendocardial ischemia ST elevation in aVR

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

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

Published on: December 28, 2012

Area of Science:

Cardiology
Emergency Medicine
Diagnostic Imaging

Background:

ST-segment elevation in lead aVR with diffuse ST depression is a recognized ECG pattern.
This pattern is traditionally linked to acute coronary syndromes, specifically left main or three-vessel coronary artery disease.
However, the diagnostic specificity of this ECG finding remains debated.

Purpose of the Study:

To report a case where the characteristic ECG pattern was associated with type A aortic dissection.
To emphasize the importance of considering differential diagnoses in patients with hemodynamic instability presenting with this ECG pattern.

Main Methods:

Case report of a 60-year-old male with chest pain and hemodynamic shock.
Electrocardiogram (ECG) interpretation revealing diffuse ST depression and ST elevation in lead aVR.
Physical examination and echocardiography leading to suspicion of type A aortic dissection.
Computed tomography (CT) scan confirming the diagnosis of type A aortic dissection.

Main Results:

The patient presented with symptoms suggestive of acute coronary syndrome.
The ECG findings prompted urgent cardiac catheterization.
Diagnosis was ultimately type A aortic dissection, not coronary artery disease.
This highlights the critical need for differential diagnosis.

Conclusions:

The ECG pattern of ST elevation in lead aVR with diffuse ST depression is not exclusive to coronary artery disease.
In patients with hemodynamic instability, this ECG finding necessitates a broad differential diagnosis.
Type A aortic dissection should be considered in the differential diagnosis for this ECG presentation.