Int J Cardiol. 2011 Nov 17;153(1):e1-2. doi: 10.1016/j.ijcard.2009.03.061. Epub 2009 Apr 7.
Exercise-induced ST-segment elevation in lead aVR accompanied by ST-segment elevation in lead V1 might be a specific finding of left main coronary artery (LMCA) stenosis. Lead aVR and lead v1 ST segment elevation has been reported, during an attack of chest pain, in patients with LMCA disease with ST segment depression in leads V3, V4 and V5 (with maximal depression in V4). ST-segment elevation in lead aVR in patients with angina at rest can be related to transmural ischemia of the basal part of the interventricular septum, frequently due to LMCA or multivessel coronary disease too. 3-vessel coronary artery disease (CAD) and LMCA disease show a frequent combination of leads with abnormal ST segments during chest pain with ST-segment depression in leads I II V4-V6, and ST-segment elevation in lead aVR. When ST-segment status in lead aVR combines with troponin T, ST-segment elevation in lead aVR and positive troponin T on admission are useful predictors of LMCA or 3-vessel CAD. We present a case of acute myocardial infarction with significant left main coronary artery stenosis, significant 3-vessel coronary artery disease and elevated troponin I at admission in an 83-year-old Italian woman. Also this case focuses attention on the importance of the recognition of the patterns suspected for LMCA and/or 3-vessel coronary disease.
在 aVR 导联中出现运动诱发的 ST 段抬高，同时 V1 导联中出现 ST 段抬高，可能是左主干冠状动脉（LMCA）狭窄的特定表现。在 LMCA 疾病患者中，在胸痛发作期间，已报道在 V3、V4 和 V5 导联中出现 ST 段压低（在 V4 导联中最大压低）的同时，aVR 和 v1 导联的 ST 段抬高。在静息性心绞痛患者中，aVR 导联的 ST 段抬高可能与间隔基底部的透壁性缺血有关，这通常与 LMCA 或多支冠状动脉疾病有关。3 支冠状动脉疾病（CAD）和 LMCA 疾病在胸痛时经常出现伴有 ST 段压低的导联和异常 ST 段，导联 I、II、V4-V6 中 ST 段抬高，aVR 导联中 ST 段抬高。当 aVR 导联的 ST 段状态与肌钙蛋白 T 结合时，aVR 导联的 ST 段抬高和入院时肌钙蛋白 T 阳性是 LMCA 或 3 支 CAD 的有用预测指标。我们介绍了一位 83 岁意大利女性的急性心肌梗死病例，该患者存在显著的左主干冠状动脉狭窄、显著的 3 支冠状动脉疾病和入院时肌钙蛋白 I 升高。该病例还强调了识别疑似 LMCA 和/或 3 支冠状动脉疾病模式的重要性。
