Left Main Stem Disease Ecg

These changes signify different severity of myocardial ischemia caused by left main coronary artery disease.

Left main stem disease ecg. Kosuge m kimura k ishikawa t ebina t shimizu t hibi k et al. Avr has gone from the forgotten lead to be equated with the worst coronary occlusion. The american journal of cardiology 2011 107 495 500. In the next post we will review the appearance and significance of hyperacute t waves which may be the first subtle sign of coronary vessel occlusion.

An early and simple predictor of severe left main and or three vessel disease in patients with non st segment elevation acute coronary syndrome. The particularity of the case is the severity of the coronary disease exposed by the test and confirmed angiographically for a patient presenting few symptoms and nonspecific clinical manifestations. 1 st elevation of 1 millimeter or greater has been shown to be 80 sensitive and 90 specific for severe left main coronary artery and or 3 vessel disease that may require coronary artery bypass grafting in some series. If there is no patent bypass graft to the left anterior descending lad or circumflex artery the disease is then referred to as unprotected left main disease uplm.

St segment elevation in avr and diffuse st segment depression in inferior and anterolateral leads is considered a feature of significant left main coronary artery disease. A significant stenosis 50 of the left main is present in 4 to 6 of patients who have undergone coronary angiography. This post will look at ecg findings associated with left main coronary artery lmca disease and explore the significance of st segment elevation in the avr forgotten lead. 2011 feb 15 107 4 495 500 abstract.

Ste in avr is often due to left main coronary artery obstruction or 4 72 and is associated with in hospital cardiovascular mortality or 5 58. The ecg shown above there is st segment elevation in avr and v1 along with st depression in inferior and lateral leads. Predictors of left main or three vessel disease in patients who have acute coronary syndromes with non st segment elevation. In this post we will look at ecg findings associated with left main coronary artery disease and explore the significance of st segment elevation in the forgotten lead.

The 2013 aha acc stemi guideline notes that multilead st depression with coexistent st elevation in lead avr has been described in patients with left main or proximal left anterior descending artery occlusion 1 and the 2018 fourth universal definition of mi added the update st segment. Early identification of lmca disease is critical because acute occlusion can cause rapid hemodynamic and electrical deterioration. Many ischemic ecg patterns are found in patients with acute left main coronary artery occlusion. The coronarography revealed a 90 stenosis of the left main the occlusion of the circumflex artery and that of an intermediary branch without lesions on the right coronary artery.

Kosuge m ebina t hibi k et al. Left main coronary artery disease on ecg left main coronary artery disease on ecg.