scholarly journals A Sign to Heaven: aVR Lead Elevation and Myocardial Infarction

2011 ◽  
Vol 11 ◽  
pp. 662-665
Author(s):  
Amir M. Nia ◽  
Natig Gassanov ◽  
Hannes Reuter ◽  
Fikret Er
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Proximal Part ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Correct Treatment ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
Long Time

Isolated ST-segment elevation only in the aVR lead, reflecting an acute myocardial infarction due to a left main coronary artery occlusion, was ignored as part of physicians' training in emergency medicine for a long time. The recognition of aVR lead elevation is becoming more accepted as a mandatory diagnostic tool, in particular for physicians working at emergency departments. We report a typical myocardial infarction with total occlusion of the proximal part of the left anterior coronary artery, presenting with ST-segment elevation in the aVR lead, which was misinterpreted as diffuse ischemia. The lacking mandatory awareness of this entity endangered prompt and correct treatment.

scholarly journals Posterior myocardial infarction with isolated ST elevations in V8 and V9: Is this an “ST elevation MI”?

CJEM ◽  
2003 ◽  
Vol 5 (02) ◽  
pp. 115-118
Author(s):  
Lance Brown ◽  
Jessica Sims ◽  
Alessandra Conforto
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Primary Angioplasty ◽  
Artery Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Artery Disease ◽  
Electrocardiogram Ecg

ABSTRACT We report a case of a 53-year-old man whose first manifestation of coronary artery disease was an acute isolated posterior myocardial infarction (IPMI). Acute IPMI is relatively uncommon and predominantly due to occlusion of the left circumflex coronary artery. IPMI is challenging to diagnose due to the absence of ST segment elevation on a standard 12-lead electrocardiogram (ECG) even in the setting of total coronary artery occlusion and transmural (Q-wave) infarct. We discuss the diagnostic implications of the absence of tall R waves in leads V1 and V2 on this patient’s ECG. The utility of posterior leads (V7 through V9) is demonstrated. The controversy surrounding the use of thrombolytic therapy or primary angioplasty in the setting of acute IPMI without ST segment elevation on a standard 12-lead ECG is reviewed.

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