Here are a case presentation and
a follow up on a patient with diffuse ST depression and ST
elevation in aVR from the EMS 12-Lead blog.
A few learning points from the post:
Multi-lead ST depression with ST
elevation in aVR suggest global subendocardial ischemia due to left
main artery stenosis or its equivalent (multi-vessel) but not
occlusion.
Rather than an unstable coronary
plaque, the syndrome often reflects myocardial oxygen supply-demand
imbalance in which case the troponin elevation represents a type 2
MI.
Treatment often consists of mitigating
those factors causing supply-demand imbalance.
When should these patients go to the
cath lab? Not always immediately, depending on clinical
circumstances. That question is addressed further in this post
from Dr. Smith's blog, which also discusses the much less common
presentation of left main occlusion.
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