Lead AVR on ECG
1. Acute myocardial infarction: ST elevation > 1.5 mm in aVR, indicative of left main coronary artery (LMCA). left anterior descending (LAD). or 3-vessel coronary dz
• LMCA clusvon has a high mortality and often refractory to
• aVR ST elevation in ACS patients: predictor of recurrent ischemic events in-hospital. heart failure, and death.
2. Pericarditis: PR elevation in aVR
• PR elevation in aVR: Subepicardial atrial injury from pericardial inflammation
• Multilead ST elevation: Differential diagnosis includes ACS vs pericarditis
- Concurrent PR elevation in aVR instead of ACS.
3. Tricyclic antidepressant (TCA) & TCA-like overdose: Prominent R wave in aVR
• Classic EKG findings: Sinus tachycardia, widened QRS and QTc interval, RAD 130°-170°, prominent terminal R wave in aVR
• Predictor of arrhythmia:
- R/S ratio in aVR > 0.7: ppv = 46%. NPV = 95%
4. Atrioventricular reentry tachycardia (AVRT) in WPW: ST elevation in aVR in narrow cornplex tachycardia
• Narrow complex tachycardia ddx: AVNRT, AVRT, atrial tachycardia
• ST elevation in aVR suggestive more of AVRT in WPW (sens 71%. spec 70%)
5. Differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in wide cornplex tachycardia
• Vereckei criteria only looks at aVR lead. Asks 4 questions. More sensitive and to detect VT than Brugada criteria.
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