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Left main coronary artery occlusion

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Dawn's picture

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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