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. 2025 Jan;9(1):109-110.
doi: 10.5811/cpcem.35284.

ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

Bruce M Lo  1 , Megyn K Christensen  2 , Katherine E Schaffer  2 , Theodore J Tzavaras  1
Affiliations

ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

Bruce M Lo et al. Clin Pract Cases Emerg Med. 2025 Jan.

Abstract

Case presentation: A 33-year-old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-segment depression. An emergent catheterization was performed, which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications.

Discussion: Previous guidelines have suggested that ST-segment elevation with diffuse ST-segment depression should be treated as a ST-elevation myocardial infarction equivalent involving either the left-main or proximal left anterior descending coronary artery. However, recent data suggests that most of these cases may not involve that region. Regardless, this electrocardiogram finding should still be a concern for acute coronary syndrome, with the need for urgent catheterization.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Electrocardiogram with ST-segment elevation in aVR (blue arrow) and diffuse ST-segment depression (red arrow).
Image 2
Image 2
Cardiac catheterization showing 99% stenosis in the left main coronary artery (arrow).
See this image and copyright information in PMC

References

    1. Wagner GS, Macfarlane P, Wellens H, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53(11):1003–11. - PubMed
    1. Harhash AA, Huang JJ, Reddy S, et al. aVR ST segment elevation: acute STEMI or Not? Incidence of an acute coronary occlusion. Am J Med. 2019;132(5):622–30. - PubMed
    1. Sood A, Singh A, Gadkari C. Myocardial infarction in young individuals: a review article. Cureus. 2023;15(4):e37102. - PMC - PubMed