{"id":26028,"date":"2018-09-21T07:02:11","date_gmt":"2018-09-21T07:02:11","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=26028"},"modified":"2024-12-09T19:11:52","modified_gmt":"2024-12-09T13:41:52","slug":"left-main-coronary-artery-disease-on-ecg","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/","title":{"rendered":"Left main coronary artery disease on ECG"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Left main coronary artery disease on ECG<\/span><\/h2>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/YEGbtshYOXc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<figure id=\"attachment_26029\" aria-describedby=\"caption-attachment-26029\" style=\"width: 640px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-26029 size-large\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2018\/09\/LMCA-likely-1024x507.jpg\" alt=\"Left main coronary artery disease on ECG\" width=\"640\" height=\"317\" \/><figcaption id=\"caption-attachment-26029\" class=\"wp-caption-text\"><em><strong><span style=\"color: #0000ff;\">Left main coronary artery disease on ECG<\/span><\/strong><\/em><\/figcaption><\/figure>\n<p><span style=\"color: #0000ff;\">ST segment elevation in aVR<\/span> and diffuse ST segment depression in inferior and anterolateral leads is considered a feature of significant left main coronary artery disease. The ECG shown above, there is ST segment elevation in aVR and V1 along with ST depression in inferior and lateral leads. ST elevation in aVR more than that in V1 is also suggestive of left main disease. In addition there is right bundle branch block pattern.<\/p>\n<p>In a study comparing acute obstruction of left main, left anterior descending (LAD) and right coronary (RCA) occlusions, aVR ST elevation of more than 0.05 mV was noted in 88% of left main (LMCA) obstruction, 43% of LAD obstruction and 8% of RCA obstruction [1]. One limitation of the study was lack of comparison with left circumflex (LCX) obstruction.<\/p>\n<p>In addition to ST elevation in aVR, this ECG also shows Q in V1 followed by a tall slurred R (QRBBB) is indicative of anterior wall infarction with right bundle branch block. The initial R of the RSR&#8217; pattern expected in right bundle branch block (RBBB) is knocked off by the infarction. Multiple supraventricular ectopics are also seen in the ECG.<\/p>\n<p>In a case reported by\u00a0Shinde RS et al, coronary angiography documented total occlusion of left coronary artery and the patient underwent emergency coronary artery bypass surgery (CABG) [2]. In that case there was ST depression in I, aVL, II, aVF and V2-V6. ST elevation was 2 mm in aVR and 1 mm in V1. This patient had reported with recent onset angina.<\/p>\n<p>Usually patients with LMCA occlusion deteriorate hemodynamically and electrically very rapidly [3]. They can present with anterior wall infarction. On other extreme, total left main coronary artery occlusion with normal ECG and left ventricular function has also been reported in literature [4]. In that patient, collaterals from right coronary artery supplied both left anterior descending and left circumflex coronary arteries.<\/p>\n<p>Significant left coronary artery narrowing of more than 50% luminal narrowing is noted in about 5% of patients undergoing coronary angiography. But total occlusion being documented on coronary angiography is extremely rare as many of them do not survive. One series documented only 6 patients in around twelve thousand cases [5].<\/p>\n<p><strong><span style=\"color: #0000ff;\">References<\/span><\/strong><\/p>\n<ol>\n<li>Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, Hina K, Kita T, Sakakibara N, Tsuji T.\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11691506\">Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V1<\/a>.\u00a0J Am Coll Cardiol. 2001 Nov 1;38(5):1348-54.<\/li>\n<li>Shinde RS, Hiremath MS, Makhale CN, Durairaj M.\u00a0Images in cardiology. ECG showing features of total left main coronary artery occlusion.\u00a0Heart. 2006 May;92(5):670.<\/li>\n<li>Bhatia V, Parida AK, Pandey AK, Kaul U. 12 lead ECG in the detection of left main coronary artery occlusion during acute coronary syndromes.\u00a0Int J Cardiol. 2007 Apr 4;116(3):e83-4.<\/li>\n<li>Singhal G, Pathak V, Mittal S. Total left main coronary artery occlusion with\u00a0normal ECG and normal LV function: A rare case. Journal of Indian College of Cardiology. 2016; 6:49-51.<\/li>\n<li>Ward DE, Valantine H, Hui W. Occluded left main stem\u00a0coronary artery report of five patients and review of\u00a0published reports. Br Heart J. 1983;49:276\u2013279.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Left main coronary artery disease on ECG 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. The ECG shown above, there is ST segment elevation in aVR and V1 along with ST depression in inferior and lateral leads. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":26029,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[],"class_list":["post-26028","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Left main coronary artery disease on ECG - ST elevation in aVR<\/title>\n<meta name=\"description\" content=\"Left main coronary artery disease on ECG - ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Left main coronary artery disease on ECG - ST elevation in aVR\" \/>\n<meta property=\"og:description\" content=\"Left main coronary artery disease on ECG - ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2018-09-21T07:02:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-12-09T13:41:52+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Left main coronary artery disease on ECG\",\"datePublished\":\"2018-09-21T07:02:11+00:00\",\"dateModified\":\"2024-12-09T13:41:52+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/\"},\"wordCount\":539,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"articleSection\":[\"ECG \\\/ Electrophysiology\",\"ECG Library\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/\",\"name\":\"Left main coronary artery disease on ECG - ST elevation in aVR\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"datePublished\":\"2018-09-21T07:02:11+00:00\",\"dateModified\":\"2024-12-09T13:41:52+00:00\",\"description\":\"Left main coronary artery disease on ECG - ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#primaryimage\",\"url\":\"\",\"contentUrl\":\"\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/left-main-coronary-artery-disease-on-ecg\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Left main coronary artery disease on ECG\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\",\"name\":\"All About Cardiovascular System and Disorders\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\",\"name\":\"Johnson Francis\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"caption\":\"Johnson Francis\"},\"logo\":{\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\"},\"description\":\"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/author\\\/jf\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Left main coronary artery disease on ECG - ST elevation in aVR","description":"Left main coronary artery disease on ECG - ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/","og_locale":"en_US","og_type":"article","og_title":"Left main coronary artery disease on ECG - ST elevation in aVR","og_description":"Left main coronary artery disease on ECG - ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads.","og_url":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/","og_site_name":"All About Cardiovascular System and Disorders","article_published_time":"2018-09-21T07:02:11+00:00","article_modified_time":"2024-12-09T13:41:52+00:00","author":"Johnson Francis","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Johnson Francis","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#article","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/"},"author":{"name":"Johnson Francis","@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"headline":"Left main coronary artery disease on ECG","datePublished":"2018-09-21T07:02:11+00:00","dateModified":"2024-12-09T13:41:52+00:00","mainEntityOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/"},"wordCount":539,"commentCount":0,"publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#primaryimage"},"thumbnailUrl":"","articleSection":["ECG \/ Electrophysiology","ECG Library"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/","url":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/","name":"Left main coronary artery disease on ECG - ST elevation in aVR","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#website"},"primaryImageOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#primaryimage"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#primaryimage"},"thumbnailUrl":"","datePublished":"2018-09-21T07:02:11+00:00","dateModified":"2024-12-09T13:41:52+00:00","description":"Left main coronary artery disease on ECG - ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads.","breadcrumb":{"@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#primaryimage","url":"","contentUrl":""},{"@type":"BreadcrumbList","@id":"https:\/\/johnsonfrancis.org\/professional\/left-main-coronary-artery-disease-on-ecg\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/johnsonfrancis.org\/professional\/"},{"@type":"ListItem","position":2,"name":"Left main coronary artery disease on ECG"}]},{"@type":"WebSite","@id":"https:\/\/johnsonfrancis.org\/professional\/#website","url":"https:\/\/johnsonfrancis.org\/professional\/","name":"All About Cardiovascular System and Disorders","description":"","publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/johnsonfrancis.org\/professional\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec","name":"Johnson Francis","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","caption":"Johnson Francis"},"logo":{"@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g"},"description":"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal","url":"https:\/\/johnsonfrancis.org\/professional\/author\/jf\/"}]}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/26028","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/comments?post=26028"}],"version-history":[{"count":1,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/26028\/revisions"}],"predecessor-version":[{"id":63708,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/26028\/revisions\/63708"}],"wp:attachment":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media?parent=26028"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/categories?post=26028"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/tags?post=26028"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}