EM Alliance ECG – Case 7

75yom, SOB, tripod position


ECG courtesy of http://www.emalliance.org


3 Comments Add yours

  1. Tatsu Kuwasaki says:


  2. Tatsu Kuwasaki says:

    OK, how did you go team?

    ST elevation in aVR and V1 has high specificity and sensitivity for the LMCA or proximal LAD occlusion.
    Additionally, STE in aVR > STE in V1 has high specificity for LMCA occlusion.
    STE in aVR > 1.5mm has mortality rate of 75%!!!

    Aspirin and even the thromobolysis is ineffective.

    These patients needs to go to the cath lab for PCI/CABG!


    Yamaji, H., Iwasaki, K., Kusachi, S., Murakami, T., Hirami, R., Hamamoto, H., … Tsuji, T. (2001). Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography: ST segment elevation in lead aVR with less ST segment elevation in lead V1. Journal of the American College of Cardiology, 38(5), 1348–1354. https://doi.org/10.1016/S0735-1097(01)01563-7


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