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Left Main Coronary Artery Occlusion

Wed, 10/24/2012 - 19:34 -- Dawn

This ECG was provided by Jamie Bisson, of E Advanced Healthcare.

The patient, in cardiogenic shock, was resuscitated in the Emergency Department, then sent to the cath lab, where his left main coronary artery was opened and stented.

Many people with complete occlusion of the left main do not survive. When there is some diminished blood flow through the blocked area in the proximal LAD or left main, this pattern may appear. Look for ST elevation in aVR greater than or equal to 1 mm, ST elevation in aVR greater than the ST elevation in V1, and widespread ST depression.   

In this ECG, aVR and V1 show ST segment elevation, with widespread ST depression. For years, aVR was virtually ignored in the literature, and considered to be only a reciprocal view of the lateral inferior wall. Now, there is convincing evidence of its usefulness in discovering proximal left coronary artery occlusion and severe triple vessel disease. ST elevation in aVR can be a reliable sign of ischemia of the basal part of the heart and the proximal IV septum.

Many people with complete occlusion of the left main do not survive. When there is diminished blood flow through the blocked area in the proximal LAD or left main, this pattern may appear. Look for ST elevation in aVR greater than or equal to 1 mm, ST elevation in aVR greater than the ST elevation in V1, and widespread ST depression.

For complete discussions on this topic, go to Life in the Fast Lane,

Dr. Smith's ECG Blog,

JACC

 

 

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Comments

Submitted by Dawn on

Hi, MarioNurse -

You will probably find the links in the above post very interesting and informative.  A 15-lead ECG is certainly very helpful in many cases. In the Cardiac Alert (or STEMI Alert) situation, with a patient who is very symptomatic, the ST elevation in aVR and V1 are enough to warrant a very rapid trip to the cath lab.  This is a marker for proximal LCA occlusion, which is affectionately known as the "widow-maker".  If you haven't already, check out the links to Life in the Fast Lane and Dr. Smith's ECG blog provided in the post.  Thanks for your participation on the ECG Guru.  We love hearing from you.

Dawn

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