asked 2 months ago
In the context of calling a STEMI Alert to a receiving hospital for suspected aVR elevation; does there need to be >1mm of elevation in aVR, with ST depression in the lateral leads? Or is the criterion completely different?
1 Answers
answered 2 months ago
Thank you for your question. aVR was once considered the "nothing" lead - a ground if you will. However, new evidence throughout the years has shown that STE in aVR with diffuse depression in a patient with chest pain is indicative of a critical left main occlusion. This is more so if there is STE in aVR, aVL and V1 with diffuse ST depression.
However, the key is in the history. STE in aVR with diffuse ST depression can be seen in the context of diffuse multivessel disease or poor endocardial perfusion secondary to a shock state (GI Bleed, PE, sepsis, etc.) When there is a clinical picture that is consistent with ischemia, and you have STE in aVR, in order for a critical left main occlusion to be considered there must be concurrent diffuse ST depression.
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