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Significance of Lead aVR in ECG

Significance of Lead aVR in ECG:

*** 1st: In a case of suspected acute coronary syndrome, presence of ST elevation in Lead aVR > 1 mm predicts either left main dse or proximal left anterior descending artery (LAD) occlusion with severe triple‑vessel disease (TVD).

ST elevation in aVR > V1 predicts acute LMCA occlusion, ST elevation in V1 > aVR is more predictive of LAD occlusion usually proximal to first septal branch.

*** 2nd : In patients having narrow complex tachycardia, presence of ST segment elevation in lead aVR favors atrioventricular reentry through accessory pathway rather than atrial ventricular nodal reentrant tachycardia as mechanism of tachycardia.

*** 3rd:  “aVR sign” is defined as R wave ≥0.3 mV or R/q ≥ 0.75 in lead aVR. It is considered as a risk factor for life‑threatening arrhythmic events in patients with Brugada syndrome.

*** 4th: Reciprocal ST segment depression and PR segment elevation (knuckle sign) in lead aVR are characteristic and help in supporting a diagnosis of acute pericarditis.

*** 5th: In patients with suspected poisoning presence of tall R wave in lead aVR along with the presence of QRS and QT prolongation should suggest the possibility of tricyclic antidepressant poisoning.

*** 6th: Both dextrocardia and lead reversal (left arm/right arm leads) mimic each other can present with P wave and QRS complex are upright in lead aVR. In case of lead reversal, the precordial pattern (V1 to V6) is normal. With dextrocardia, the QRS voltage gradually diminishes from V1 through V6

*** 7th: Left Ventricular Aneurysm (Goldbergers sign) : In patients with Anterior wall MI with persistent ST elevation in chest leads and tall R in lead aVR is indicative of ventricular aneurysm (Goldbergers sign). In acute ST elevation lead aVR usually shows negative QRS.

*** 8th: Tension Pneumothorax: The ECG changes are more common in left pneumothorax, with or without tension, including a right QRS axis deviation, low QRS voltage, reduced precordial R-wave voltage, and anterior T-wave inversion. Marked PR-segment elevation in inferior leads and reciprocal PR-segment depression in lead aVR.

*** 9th: Atrial infarction: In the presense of acute Inferior wall MI, PR segment elevation in inferior leads and PR segment depression in lead aVR is suggestive of Atrial infarction.

*** 10th: Acute pulmonary embolism:  Acute right ventricular overload could also manifest as ST-segment elevation in lead aVR.


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