Electrocardiographic Significance of Lead aVR in Acute Myocardial Infarction
Journal Title: Journal of Medical Science And clinical Research - Year 2018, Vol 6, Issue 10
Abstract
Introduction: Role of lead aVR in localizing the level of obstruction in AMI has generated considerable interest in recent times. There is a plethora of articles studying the utility of lead aVR (ST segment elevation) in AMI with conflicting and contradictory results. Methodology: This prospective study comprised of 100 subjects of Acute myocardial infarction (AMI) was aimed to determine utility of ST segment changes in lead aVR in terms of ST elevation in prediction of coronary artery involvement & correlating culprit coronary artery lesion on coronary angiogram (CAG). A12 lead ECG was done at admission and CPKMB level was done in all patients. CAG (coronary angiogram) was performed within 72 hrs. of hospitalisation in most of the cases except few in whom CAG was performed within 7 days. On ECG, lead aVR changes in the form of ST elevation were noted in terms of culprit coronary artery and were correlated and confirmed on CAG. Results: Analysis of admission ECG revealed ST elevation in lead aVR in 28% of the cases. On CAG single & double vessel disease was observed in majority of the cases. LMCA occlusion was seen in 12% cases. (12 out of100) 10 (35.7%) cases out of 28 who showed ST segment elevation in aVR had significant LMCA occlusion on CAG, Diabetes, cardiogenic shock & Triple vessel disease were found as independent predictors of elevated ST segment in lead aVR. It was statistically highly significant CPKMB levels were significantly high in cases with elevated ST in lead aVR (p = <0.0001). Correlation between elevated ST in lead aVR & significant LMCA occlusion (>50%) on CAG was found statistically significant p = <0.0001, Odds ratio = 19.44 95% CI (3.55-190.30).with Sensitivity of 83.3%, Specificity 87.5%, positive predictive value 35.71%, negative predictive value as 97.22% & accuracy of 80%. All 28 cases with elevated ST segment in lead aVR showed significant LAD occlusion on CAG. While 72 cases without ST elevation in lead aVR revealed LAD occlusion in 54 (75%) cases. this difference was statistically significant p =0.003. but sensitivity, specificity positive & negative predictive value & diagnostic accuracy (34%,1%, 1% 28.8% & 28.18% respectively) is less than LMCA prediction with ST segment elevation in lead aVR. Conclusion: ST elevation in lead aVR has more predictability for significant occlusion of LMCA on CAG than LAD
Authors and Affiliations
Dr Milind Vyawahare
Keywords
Related Articles
- EP ID EP512403
- DOI -
- Views 70
- Downloads 0
Cellularity Pattern in Induced Sputum in School Aged Asthmatics
Background: Many inflammatory phenotypes previously described in adults with asthma: eosinophilic and non-eosinophilic. Treatment strategies based on these phenotypes have been successful. This study tried to evaluate sp...
Pattern of Musculoskeletal Affectation among Poliomyelitic Patients in Kano, Nigeria
Background: Poliomyelitis is a contagious and infectious disease caused by the polio virus. The disease has been eradicated from developed countries but still remains one of the most crippling diseases affecting children...
Cross Sectional Study of Body Mass Index, Blood Pressure and Age among Medical and Paramedical Students of Medical College in Delhi
Objective: To correlates changes in body mass index (BMI) and obesity with blood pressure, age and waist-to-hip ratio in adults as well as to identify possible risk groups with undesirable trends in obesity by assessing...
Survey of Foot Complications among Patients Attending Diabetic Foot Clinic in A Tertiary Care Center
Introduction: The prevalence of diabetes is increasing worldwide resulting in foot complications, which leads to poor quality of life and increased cost of living. Aim: The aim of this study was to understand the spectru...
A Questionnaire Survey on use of Low Flow Anesthesia by Anesthesiologists
Background: The routine use of low flows can cut down anesthesia costs up to 75%. The amount of volatile anesthetic agents extracted is directly proportional to the fresh gas flow (FGF) into the breathing circuit and sys...