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AVR ST elevation
Contents [hide]
1 Background
2 Clinical Features
3 Differential Diagnosis
3.1 ST Elevation
4 Evaluation
5 Management
6 External Links
7 References
Background
AVR elevation is commonly thought of as a sign of Left
Main Coronary Artery (LMCA) occlusion. However, STE
0.5mm or greater in lead aVR to be present in 78% of
patients with and 14% of patients without LMCA
stenosis.[1]
Use > 1mm and the clinical status of a patient if
activating the cath lab based on aVR and concern for a
STEMI
Clinical Features
Differential Diagnosis
ST Elevation
Cardiac
ST-segment elevation myocardial infarction (STEMI)
Post-MI (ventricular aneurysm pattern)
Previous MI with recurrent ischemia in same area
Wellens' syndrome
Coronary artery vasospasm (eg, Prinzmetal's
angina)
Coronary artery dissection
Pericarditis
Myocarditis
Aortic dissection in to coronary
Left ventricular aneurysm
Left ventricular pseudoaneurysm
Early repolarization
Left bundle branch block
Left ventricular hypertrophy (LVH)
Myocardial tumor
Myocardial trauma
RV pacing (appears as Left bundle branch block)
Brugada syndrome
Takotsubo cardiomyopathy
AVR ST elevation
Other thoracic
Pneumomediastinum
Pneumothorax
Pulmonary embolism
Metabolic
Drugs of abuse (eg, cocaine, crack, meth)
Cocaine chest pain
Hyperkalemia (only leads V1 and V2)
Hypothermia ("Osborn J waves")
Medications
Tricyclic (TCA) toxicity
Digoxin
Evaluation
Isolated elevation AVR is poorly specific for a
LMCA. The following are other causes of aVR
elevation:
Nontraumatic thoracic aortic dissection
Massive Pulmonary Embolism
Massive GI bleed
Left bundle branch block (LBBB)
Left Ventricular Hypertrophy (LVH) with Strain Pattern
Severe atrial tachydysrhythmias
Management
External Links
Amal Mattu aVR podcast
References
1. Kosuge M et al. Predictors of Left Main or Three-
Vessel Disease in Patients Who Have Acute
Coronary Syndromes with Non-ST-Segment
Elevation. Am J Cardiol 2005; 95: 1366 – 9. PMID:
15904646
Authors: Daniel Eggeman, Daniel Ostermayer, Ross
Donaldson
Category: Cardiology
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This page was last edited 14:41, 6 April 2019 by Ross
Donaldson.
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