scholarly journals Acute Coronary Syndromes Presenting with Transient Diffuse ST Segment Depression and ST Segment Elevation in Lead aVR not Caused by “Acute Left Main Coronary Artery Occlusion”: Description of Two Cases

2012 ◽  
Vol 18 (2) ◽  
pp. 204-209 ◽  
Author(s):  
Edward Kim ◽  
Yochai Birnbaum
Keyword(s):  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Left Main Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr

VALUE OF ST-SEGMENT ELEVATION IN LEAD AVR IN PREDICTING LEFT MAIN AND OR 3-VESSEL DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 59-63
Author(s):  
Thanh Hung Dieu ◽  
Anh Vu Nguyen
Keyword(s):  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Independent Predictor ◽  
Left Main ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr ◽  
Sensitivity Specificity

Objects: We assessed the ability of ST-segment elevation in lead aVR to predict left main and/or 3-vessel disease (LM/3VD) in patients with acute coronary syndromes (ACS). Meterial and Method: 410 patients with ACS, who underwent coronary angiography, were evaluated. Results: 131 (31.9%) patients have been LM/3VD. ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD with sensitivity, specificity, positive predictive value PPV) and negative predictive value (NPV) 74.0%, 78.1%, 61.4% and 86.5%, respectively (p<0.001). ST segment elevation > 0.05 mV in leads aVR with ST segment depression in leads V4-V6 have related LM/3VD with sensitivity, specificity, PPV and NPV 44.3%, 92.8%, 74.4% and 75.2%, respectively (p<0.001). ST segment elevation > 0.1 mV in leads aVR have related LM/3VD with sensitivity, specificity, PPV and NPV 51.9%, 87.1%, 65.1% and 79.4%, respectively (p<0.001). Conclusions: ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD in patients with ACS. Key words: Acute coronary syndromes, ST-segment elevation, aVR

scholarly journals Prediction of Left Main Coronary Artery Occlusion by ST Segment Elevation in Lead aVR Greater than that in Lead V1 in Acute Coronary Syndrome

2017 ◽  
Vol 9 (2) ◽  
pp. 77-82
Author(s):  
Abdul Azeez Ahemd ◽  
Mahboob Ali ◽  
Abdullah Al Shafi Majumder ◽  
M Atahar Ali ◽  
Md Shafiqur Rahman Patwary ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Ventricular ◽  
Left Main ◽  
Predictive Values ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Group I ◽  
St Segment ◽  
Lead Avr

Background: The electrocardiogram (ECG) predicting an acute obstruction of the LMCA, which requires immediate aggressive treatment, is very important for early diagnosis. We correlated ST segment elevation in lead aVR greater than that in lead V• with coronary angiographic diagnosis of LMCA occlusion in patients with acute coronary syndrome.Methods: Cross sectional analytical study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from August 2011 to July 2012. Total 90 patients were included purposively. Study population was divided into two groups. Group I- Patients with ST segment elevation in aVR greater than ST segment elevation in V• (n=45) and group II- Patients with ST segment elevation in aVR less than that in lead V• (n=45). In hospital outcomes were observed for cardiogenic shock, left ventricular failure, hypotension, arrhythmia and death.Results: Acute LVF was significantly (P<0.05) higher in group I but other complications were not significant (P>0.05) between two groups. LM involvement was significantly higher in group I (91.1% vs. 20.0%, p<0.05). ST segment elevation in aVR greater than ST segment elevation in V• (n=45) for prediction of LM significant disease has got a sensitivity of 82.0%, specificity 90.0%, accuracy 85.6%, positive and negative predictive values were 91.1% and 80.0% respectively.Conclusion: ST segment deviation in lead aVR greater than that in lead V1 is supposed to be a positive predictor of left main coronary artery obstruction with highly sensitivity and accuracy. Precordial leads V1 and V6 can also predict the critical LMCA obstruction in patients with acute coronary syndrome.Cardiovasc. j. 2017; 9(2): 77-82

scholarly journals Cardiac arrest due to critical stenosis of a bicuspid aortic valve mimicking left main coronary artery occlusion on ECG

2018 ◽  
pp. bcr-2018-225307
Author(s):  
Abhinav Saxena ◽  
Nitin Sabharwal ◽  
Bernard Topi ◽  
Gregory Crooke
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Main Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
St Depression ◽  
St Segment

A 49-year-old man presented to the emergency room after a cardiac arrest. On arrival, the patient’s ECG showed ST-segment elevations in the aVR and anteroseptal leads with diffuse ST depression suggestive of left main coronary artery occlusion. Subsequent coronary catheterisation showed normal coronaries but revealed severe stenosis of his bicuspid aortic valve. A surgical replacement of the aortic valve was performed, and the patient recovered successfully.

scholarly journals Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

2008 ◽  
Vol 65 (10) ◽  
pp. 769-773
Author(s):  
Bozidarka Knezevic ◽  
Goran Nikolic ◽  
Sinisa Dragnic ◽  
Ljilja Music ◽  
Aneta Boskovic
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Left Main Coronary Artery ◽  
Stable Condition ◽  
Left Main ◽  
St Segment ◽  
Coronary Syndromes

Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS) are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI) centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

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