Evolution of our understanding of the aVR sign.

Abstract:

:In patients presenting with signs and symptoms of an acute coronary syndrome (ACS) the combination of multilead ST depression and ST elevation in lead aVR, the electrocardiographic "aVR sign," has been associated with severe left main coronary artery stenosis or diffuse coronary artery disease and a high risk of death. Recent guidelines even suggest that the aVR sign may represent an ST-elevation myocardial infarction (STEMI) equivalent and therefore, an indication for emergent cardiac catheterization and reperfusion. The specificity of the aVR sign for left main disease, however, has been questioned as multiple additional high-risk clinical conditions have also been shown to be associated with the aVR sign. The purpose of this review is to provide a historic background of the aVR sign and to summarize the evolution of our understanding of this important electrocardiographic (ECG) phenomenon. Using two illustrative cases, we wish to highlight the significant risks associated both with under-appreciation of the aVR sign as well as hastily overreacting to the aVR sign.

journal_name

J Electrocardiol

authors

Gibbs MA,Leedekerken JB,Littmann L

doi

10.1016/j.jelectrocard.2019.07.014

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

121-124

eissn

0022-0736

issn

1532-8430

pii

S0022-0736(19)30548-5

journal_volume

56

pub_type

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