Prognostic significancy of ST elevation commonly underestimated lead aVR in patients with NSTE acute coronary syndrome: Case report

Introduction: The most electrocardiographers consider lead aVR as giving reciprocal information from the left lateral side, being already covered by the leads aVL, II, V5 and V6. This has been the reason that lead aVR has become largely ignored. Recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS. STE aVR> 1mm, especially if it is associated with ST depression in more than 8 sink, especially lateral, is an important predictor of serious coronary events and sudden cardiac death. AIM: is to highlight the importance of the information provided by the lead aVR in patients with acute coronary syndromes. Materials and methods: In the case report used a retrospective analysis of available medical records. Case report: Man P.S. 67 yr. the smoker with hypertension, diabetes, hyperlipidemia and family history of coronary disease, occurs in Emergency Medical Service of Vrbas because of the chest pain with arrhythmia, he woke up from a dream. Anginal pain was in the beginning of the effort now occurring in peace. EKG showed STE around 2mm in aVR and ST depression in nine, mostly in lateral leads. This implied a probable left main stenosis or three vessel disease with a high risk for serious cardiovascular events. Angiographically confirmed-vessel disease and a stent is implanted in the LCX with optimal results. Conclusion: ST elevation in aVR indicates LMCA stenosis or proximal LAD stenosis or 3-vessel disease, and when accompanied by ST depression in more than 8 leads, is a predictor of serious CV events and sudden cardiac death (SCD). Size ST elevation in aVR is in direct proportion to the seriousness of cardiovascular events and SCD. Case report confirmed the published results of the studies