Heart 2000;83:657-660 ( June )

Cardiovascular medicine

Improving the ECG classification of inferior and lateral myocardial infarction by inversion of lead aVR I B A Menown, A A J Adgey

Regional Medical Cardiology Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK

Correspondence to: Professor Adgey email: jennifer.adgey{at}royalhospitals.n-i.nhs.uk

Accepted 29 February 2000

OBJECTIVETo assess whether the use of inverted lead aVR (aVR) would improve the classification of acute inferior or lateral myocardial infarction presenting with ST elevation.
DESIGNObservational study. The presence of  1 mm ST elevation in lead aVR (derived by manual assessment of ST depression in conventional lead aVR) was determined by a single investigator, blinded to patient outcome.
PATIENTS173 consecutive patients with chest pain for  12 hours and ST elevation of  1 mm in inferior leads (II, III, aVF) or lateral leads (I, aVL, V5, V6), excluding those with anterolateral ST elevation.
MAIN OUTCOME MEASUREIncidence of ST elevation in lead aVR in patients with inferior or lateral ST elevation, or both.
RESULTSST elevation in lead aVR was present in 25 of 136 patients (18%) with inferior but no lateral ST elevation (indicating greater superior involvement) and in three of 11 patients (27%) with lateral but no inferior ST elevation (indicating greater inferior involvement). ST elevation in lead aVR bridged the gap between inferior and lateral ST elevation in 15 of 25 (60%) patients with inferior and lateral chest lead (V5/V6) ST elevation, and in all patients with inferior and lateral limb lead (I/aVL) ST elevation. The presence of ST elevation in lead aVR was associated with a larger infarct size as defined by median peak creatine kinase on serial sampling: 1780 v 987  mmol/l; p = 0.021.
CONCLUSIONSUse of lead aVR improves the ECG classification of acute inferior or lateral acute myocardial infarction and thus may be useful as part of the routine 12 lead ECG assessment of such patients.


Keywords: electrocardiography; acute myocardial infarction

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© 2000 by Heart
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