Case Report: A newly identified cause of ST-segment elevation in lead aVR
1Department of Cardiology, The 305 Hospital of People's Liberation Army of China, Beijing, China.
Insights
ST elevation in lead aVR in post-coronary artery bypass grafting (CABG) patients can indicate left subclavian artery stenosis. This condition can compromise graft flow, leading to myocardial ischemia and requiring endovascular treatment.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- ST-segment elevation in lead aVR typically indicates left main or triple-vessel coronary artery disease.
- In patients who have undergone coronary artery bypass grafting (CABG), this ECG finding necessitates exploring alternative causes of myocardial ischemia, especially when grafts are patent.
Background:
ST-segment elevation in lead aVR typically signifies left main or triple-vessel disease. In post-coronary artery bypass grafting (CABG) patients, this pattern, alongside patent grafts, necessitates investigating alternative causes of myocardial ischemia.
Case Presentation:
A 74-year-old male post-CABG presented with angina and ECG showing ST elevation in aVR with diffuse depression. Angiography revealed severe native coronary disease but patent grafts, including left internal mammary artery (LIMA) to left anterior descending artery. Persistent symptoms prompted further evaluation, which identified a critical left subclavian artery stenosis, compromising LIMA flow.
Conclusion:
This case identifies left subclavian artery stenosis as a cause for aVR ST elevation in post-CABG patients by limiting LIMA graft inflow. It emphasizes the importance of evaluating extracoronary vascular lesions in recurrent ischemia despite patent grafts. Recognition and endovascular treatment of this condition can rapidly resolve symptoms and ECG abnormalities.
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