Lead AVR on ECG
1. Acute myocardial infarction: ST ...

Lead AVR on ECG

1. Acute myocardial infarction: ST elevation > 1.5 mm in aVR, indicative of left main coronary artery (LMCA). left anterior descending (LAD). or 3-vessel coronary dz

  • LMCA clusvon has a high mortality and often refractory to

  • aVR ST elevation in ACS patients: predictor of recurrent ischemic events in-hospital. heart failure, and death.

2. Pericarditis: PR elevation in aVR

  • PR elevation in aVR: Subepicardial atrial injury from pericardial inflammation

  • Multilead ST elevation: Differential diagnosis includes ACS vs pericarditis

      - Concurrent PR elevation in aVR instead of ACS.

3. Tricyclic antidepressant (TCA) & TCA-like overdose: Prominent R wave in aVR

  • Classic EKG findings: Sinus tachycardia, widened QRS and QTc interval, RAD 130°-170°, prominent terminal R wave in aVR

  • Predictor of arrhythmia:

      - R/S ratio in aVR > 0.7: ppv = 46%. NPV = 95%

4. Atrioventricular reentry tachycardia (AVRT) in WPW: ST elevation in aVR in narrow cornplex tachycardia

  • Narrow complex tachycardia ddx: AVNRT, AVRT, atrial tachycardia

  • ST elevation in aVR suggestive more of AVRT in WPW (sens 71%. spec 70%)

5. Differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in wide cornplex tachycardia

  • Vereckei criteria only looks at aVR lead. Asks 4 questions. More sensitive and to detect VT than Brugada criteria.

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