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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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lunes, 15 de agosto de 2016

ST-Segment Elevation in Lead aVR

aVR
R.E.B.E.L.EM - Posted by Salim Rezaie - March 14, 2016
"Lead aVR is a commonly ignored lead and I have even heard of it referred to as the Rodney Dangerfield of ECG leads as it gets no respect. I have anecdotally heard many EM physicians activate the cath lab for STE in lead aVR and many cardiologists say that these are not STEMI patients. So is lead aVR now getting too much respect? Well, I thought it would be a great idea to bring the great Amal Mattu on to the show to answer a few questions for us regarding STE in lead aVR.
If you don’t know Amal Mattu by now, I am not sure where you have been. Currently he is a tenured professor of Emergency Medicine at the University of Maryland School of Medicine in Baltimore. He has presented at numerous national and international conferences on ECG interpretation, published several books on the topic and if you want more from him just checkout his site ecgweekly.com...
Some Important Points made by Amal:
  • STE in aVR Should be Concerning IF you have a patient with:
    • Worrisome/Concerning Symptoms (Cardiopulmonary Symptoms) AND…
    • ST-Segment Depression in Several Other Leads
  • Don’t worry so much about STE 0.5mm or less in lead aVR, because it lacks specificity. Using 1.0mm or greater in lead aVR, has better specificity
  • Patients with ACS due to LMCA Blockage, Triple Vessel Disease, or Proximal LAD Blockage will look “sick” due to global cardiac ischemia. This narrows the number of patients we would consider activating the cath lab for with STE in aVR.
Clinical Bottom Lines:
  1. ST-Segment Elevation in Lead aVR is NOT SPECIFIC for an acute LMCA Lesion, Acute Proximal LAD Lesion, or Acute Triple Vessel Disease
  2. Correlate Your ECG with the Patient’s Clinical Status
  3. We Should use STE in aVR of ≥1.0mm as STE in aVR of ≤0.5mm is Non-Specific"