Too busy studying for the inservice to be Bored Review

1. Inferior MI 2. ST depressions in Lateral Leads, 3. Most commonly RCA (especially if right sided infarction too). Less often LCx. Rarely LAD. How straightforward is that? 4. Do a RIGHT Sided ECG to look for right ventricular infarction

1. Lateral MI 2. ST depressions in inferior leads 3. LAD/LCx 4. none

1. Anterior MI (V3-V4 are septal)  2. ST depressions in inferior leads 3.  LAD 4. none

1/2. Posterior MI! (V1, V2 are the reciprocal leads to a posterior MI – whose ST elevations aren’t evaluated on a normal 12 lead ECG). 3. Circumflex, maybe branch of RCA (posterior descending) 4. If you see these, do a posterior ECG!!!

You may think this isn’t an MI because it’s not “greater than 1mm ST elevation in contiguous leads”, but, in fact, lead aVR has no contiguous leads. ST elevation in aVR on it’s own is concerning for Left Main Artery occlusion. If this elevation has reciprocal st depressions in the rest of the leads, it may also be secondary to high stress – severe anemia, sepsis, PE, head bleeds that cause a lower flow state to someone with triple vessel disease.

Issue: Due to its location + the fact that it sometimes gives redundant information (reciprocal information covered by leads aVL, II, V5 and V6), we often ignore it

Studies show that ST segment elevation in aVR strongly predicted proximal LAD

aVR ST segment elevation greater than the ST segment elevation in V1 predicts acute left main coronary artery (LMCA) occlusion with a sensitivity of 81% and a specificity of 80%

1. TCA/sodium channel blocker Poisonings (Terminal R wave) 2. PE (acute right ventricular overload is often reflected in the EKG as ST-segment elevation in lead aVR) 3. Arrythmias (a dissociated, negative P-wave in lead aVR is useful in the wide QRS tachycardia in diagnosing a ventricular origin of the arrhythmia)