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Left main occlusion :
- Widespread horizontal STD
most prominent in leads I, II and V4-6 ( 方向和 aVR 最相反的 )
- STE in aVR ≥ 1mm
- STE in aVR ≥ V1
* ST elevation in aVR :
is not entirely specific to incomplete LMCA occlusion
It may also be seen with :
1. Proximal LAD occlusion
2. Severe TVD
3. Diffuse subendocardial ischemia
– Due to O2 supply/demand mismatch,
– Following resuscitation from cardiac arrest
4. Aortic Stenosis, Pulmonary embolism, aortic dissection
- Patients with < 1mm STE in aVR
may safely receive clopidogrel/prasugrel
during the initial treatment of their ACS as they are unlikely to proceed to urgent CABG.
- Patients with ≥ 1 mm STE in aVR
may potentially require early CABG;
therefore these patients should ideally be discussed
with the interventional cardiologist (± cardiac surgeon) before thienopyridines are given.
LMCA Mimics : Tachycardia-Related ST Depression
Widespread STD (+ reciprocal STE in aVR)
is a common finding in patients with SVT such as AVNRT or atrial flutter.
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