Francis Bernard R, Arshad Nouman, El-Din Mohammad, Antoun Ibrahim
Department of Cardiology Kettering General Hospital Kettering UK.
Department of Cardiovascular Sciences University of Leicester Leicester UK.
Clin Case Rep. 2025 Jul 29;13(8):e70671. doi: 10.1002/ccr3.70671. eCollection 2025 Aug.
ST elevation in aVR on the electrocardiogram (ECG) indicates high-risk acute coronary syndrome (ACS) but is rarely reported in pulmonary embolisms (PEs). We present a 47-year-old female with a history of PE and ankylosing spondylitis admitted for chest pain, nausea, and an episode of possible collapse. Her ECG showed ST elevation in aVR with anterolateral ST depressions, prompting a normal emergency coronary angiogram. Bedside echocardiography revealed right ventricular (RV) dilatation, and lab tests showed elevated D-dimer levels and troponin. Urgent computed tomography of the pulmonary arteries (CTPA) confirmed large bilateral PEs. The patient was treated with Enoxaparin and transitioned to Warfarin, resulting in symptom improvement. ST-segment elevation in lead aVR may mimic ACS but suggests significant conditions like PE, often from RV strain and impaired coronary blood flow due to acute RV failure. Clinicians should suspect PE in patients with aVR changes, especially with relevant clinical history and signs of RV pressure overload on echocardiography, to prevent misdiagnosis and ensure timely care.
心电图（ECG）上aVR导联ST段抬高提示高危急性冠状动脉综合征（ACS），但在肺栓塞（PE）中很少见。我们报告一名47岁女性，有PE和强直性脊柱炎病史，因胸痛、恶心及一次可能的晕厥发作入院。她的心电图显示aVR导联ST段抬高伴前侧壁ST段压低，急诊冠状动脉造影正常。床旁超声心动图显示右心室（RV）扩张，实验室检查显示D - 二聚体水平和肌钙蛋白升高。紧急肺动脉计算机断层扫描（CTPA）证实双侧大面积PE。患者接受依诺肝素治疗并转为华法林治疗，症状改善。aVR导联ST段抬高可能酷似ACS，但提示如PE等重要疾病，常因急性RV衰竭导致RV应变和冠状动脉血流受损。临床医生对有aVR导联变化的患者应怀疑PE，尤其是有相关临床病史且超声心动图有RV压力过载体征时，以防止误诊并确保及时治疗。
