Journal of Electrocardiology
Volume 42, Issue 2 , Pages 112-117 , March 2009

Determinants of ST-segment level in lead aVR in anterior wall acute myocardial infarction with ST-segment elevation

  • Munenori Kotoku, MD

      Affiliations

    • Internal Medicine 2, Oita University, Yufu, Japan
    • ,
  • Akira Tamura, MD

      Affiliations

    • Internal Medicine 2, Oita University, Yufu, Japan
    • Corresponding Author InformationCorresponding author. Internal Medicine 2, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu 879-5593, Japan. Tel.: +81 0 97 586 5804; fax: +81 0 97 549 4245.
    • ,
  • Yusei Abe, MD

      Affiliations

    • Division of Cardiovascular Medicine, Almeida Memorial Hospital, Oita, Japan
    • ,
  • Junichi Kadota, MD, PhD

      Affiliations

    • Internal Medicine 2, Oita University, Yufu, Japan

Received 24 July 2008

References 

  1. Gorgels APM, Engelen DJM, Wellens HJJ. Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography. J Am Coll Cardiol. 2001;38:1355
  2. Sgarbossa EB, Barold SS, Pinski SL, Wagner GS, Pahlm O. Twelve-lead electrocardiogram: the advantages of an orderly frontal lead display including lead −aVR. J Electrocardiol. 2004;37:141
  3. Williamson K, Mattu A, Pautz CU, Binder A, Brady WJ. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006;24:864
  4. Gorgels AP, Vos MA, Mulleneers R, de Zwaan C, Bär FW, Wellens HJ. Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris. Am J Cardiol. 1993;72:999
  5. Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, et al. Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography: ST segment elevation in lead aVR with less ST segment elevation in lead V1. J Am Coll Cardiol. 2001;38:1348
  6. Nair R, Glancy L. ECG discrimination between right and left circumflex coronary arterial occlusion in patients with acute inferior myocardial infarction: value of old criteria and use of lead aVR. Chest. 2002;122:134
  7. Kosuge M, Kimura K, Ishikawa T, et al. ST-segment depression in lead aVR predicts predischarge left ventricular dysfunction in patients with reperfused anterior acute myocardial infarction with anterolateral ST-segment elevation. Am Heart J. 2001;142:51
  8. Aygul N, Ozdemir K, Tokac M, et al. Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and in-hospital outcome in ST-elevation myocardial infarction: an electrocardiographic predictor of poor prognosis. J Electrocardiol. 2008;41:335
  9. Kosuge M, Kimura K, Ishikawa T, et al. ST-segment depression in lead aVR: a useful predictor of impaired myocardial reperfusion in patients with inferior acute myocardial infarction. Chest. 2005;128:780
  10. Barrabés JA, Figueras J, Moure C, Cortadellas J, Soler-Soler J. Prognostic value of lead aVR in patients with a first non–ST-segment elevation acute myocardial infarction. Circulation. 2003;108:814
  11. Kosuge M, Kimura K, Ishikawa T, et al. Combined prognostic utility of ST segment in lead aVR and troponin T on admission in non-ST-segment elevation acute coronary syndromes. Am J Cardiol. 2006;97:334
  12. The TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. N Engl J Med. 1985;312:932
  13. Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985;5:587
  14. Lew AS, Hod H, Cercek B, Shah PK, Ganz W. Inferior ST segment changes during acute anterior myocardial infarction: a marker of the presence or absence of concomitant inferior wall ischemia. J Am Coll Cardiol. 1987;10:519
  15. Sapin PM, Musselman DR, Dehmer GJ, Cascio WE. Implications of inferior ST-segment elevation accompanying anterior wall acute myocardial infarction for the angiographic morphology of the left anterior descending coronary artery morphology and the site of occlusion. Am J Cardiol. 1992;69:860
  16. Tamura A, Kataoka H, Nagase K, Mikuriya Y, Nasu M. Clinical significance of inferior ST elevation during acute anterior myocardial infarction. Br Heart J. 1995;74:611
  17. Engelen DJ, Gorgels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol. 1999;34:389
  18. Tamura A, Kataoka H, Mikuriya Y. Electrocardiographic findings in a patient with pure septal infarction. Br Heart J. 1991;65:166
  19. Dower GE, Nazzal SB, Pahlm O, et al. Limb lead of the electrocardiogram: sequencing revisited. Clin Cardiol. 1990;13:346
  20. Anderson ST, Pahlm O, Selvester RH, et al. Panoramic display of the orderly sequenced 12-lead ECG. J Electrocardiol. 1994;27:347
  21. Pahlm US, Pahlm O, Wagner GS. The standard 11-lead ECG: neglect of lead aVR in the classical limb lead display. J Electrocardiol. 1996;29(suppl):270
  22. Sgarbossa EB, Garodl S, Pinski SL, et al. Twelve-lead electrocardiogram: the advantages of an orderly frontal lead display including lead −aVR: editorial. J Electrocardiol. 2004;37:141
  23. Wagner GS, Pahlm-Webb U, Pahlm O. Use of the 24-lead “standard” electrocardiogram to identify the site of acute coronary occlusion: a review paper. J Electrocardiol. 2008;41:238
  24. Levine HD, Ford RV. Subendocardial infarction: report of six cases and critical survey of the literature. Circulation. 1950;1:246
  25. Cook RW, Edwards JE, Pruitt RD. Electrocardiographic changes in acute subendocardial infarction. I: large subendocardial and large nontransmural infarcts. Circulation. 1958;18:603
  26. Cook RW, Edwards JE, Pruitt RD. Electrocardiographic changes in acute subendocardial infarction. II: small subendocardial infarcts. Circulation. 1958;18:613

PII: S0022-0736(08)00437-8

doi: 10.1016/j.jelectrocard.2008.10.006

Journal of Electrocardiology
Volume 42, Issue 2 , Pages 112-117 , March 2009

Article Tools

* Image Usage & Resolution