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  • Michael D  - aVR - Get's No Respect!
    In support for your excellent presentation, FYI:
    The ECG in Emergency Decision Making by Hein Wellens (remember Wellen's syndrome?) 1992, Chapter 2, ECG Identification of HIGH-RISK Patients With Unstable Angina -
    Left Mainstem and Three-Vessel Disease:

    ECG Recognition
    If there is ST segment elevation in leads V1 and aVR plus ST segment depression in eight or more leads in a patient with unstable angina, the chance of having a severe left mainstem or three-vessel disease is very high (71%).*

    * Gorgels et al: An electrocardiographic pattern, characteristic for extensive myocardial ischemia. Circulation 78 (Suppl. II): 1988.
  • Nicholas Leonard  - MD
    I also read the article and within 1 week had a 75 yo female present with anginal quality cp, had ECG with distinct inferior, anterior, lateral ST depression. Her only ST elevation was 2 mm in AVR. I activated the STEMI team. The Cardiologist reviewed the ECG and felt the cath team activation was not warrented, but since they were already en route, she got cathed anyway. She had a 95% left main lesion and went for CABG. The cardiologist did not seem to appreciate the significance of the AVR st elevation. I plan to follow up with him on this. Thanks!!!
  • Vince D
    Had a patient with ST-depression in lateral, inferior, and anterior leads with ST-elevation in aVR that had a 100% occlusion of the left-main (in addition to 3 other blocks). Like the poster above, the cardiologist didn't appreciate the aVR findings in this case either.
  • Jason Foreman  - MD
    Just days after your recent EMRAP on EKG and AVR ST elevation... I had a classic story chest pain in a middle-aged male with isolated ST elevation in AVR, mild depression laterally. I activated Code STEMI, patient went to cath lab and had 100% occlusion of prox LAD, and did well. I had to teach the cardiologist about the AVR findings... thank you EMRAP!

EMRAPTV Episode 68: aVR - Gets No Respect!
A patient with syncope. A resident called Santos. An ECG expert called Mattu. A reference to Dangerfield. Makes for a great episode. See more on ECG reading at
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