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Significance of avR lead
- 1. aVR SIGNIFICANCE Jaya Pradhap.V B.Sc Cardiac Technology Dept of Cardiac Electrophysiology and pacing
- 3. CORONARY ARTERY DISEASE •Helps in differentiating LMCA and proximal LAD occlusion •ST elevation in aVR > v1 suggest LMCA occlusion •In distal segment occlusion,no ST elevation is seen rather than ST depression is observed
- 7. ATRIAL INFARCTION •PR elevation is seen in inferior leads •PR depression in aVR
- 9. •Patient with AWMI with persistent ST elevation in chest leads and tall R wave in aVR suggest ventricular aneurysm. •In acute ST elevation aVR usually shows negative. Left ventricular Aneurysm
- 11. LAFB And IWMI •Predominantly negative QRS in inferior leads. •aVR shows initial r wave in inferior wall MI. •aVR shows terminal R wave in LAFB.
- 14. •Disassociated negative p wave . •Tall R wave in aVR. VENTRICULAR TACHYCARDIA
- 16. SUPRAVENTRICULAR TACHYCARDIA •Positive P wave is seen when atria activated in caudocranial direction. •Eg :atrioventricular reentry tachycardia,left atrial tachycardia PRE EXCITATION SYNDROME •AVRT was differentiated from AVNRT and AT with a sensitivity of 71% and a specificity of 70%. •ST elevation in aVR strongly suggestive of WPW syndrome. LEFT ATRIAL TACHYCARDIA •Positive P wave in aVR •Negative P wave in v5 and v6 suggestive of left atrial origin.
- 19. ACUTE PERICARDITIS •In pericarditis ,PR and ST segment discordance is observed. •In myocardial infarction, PR and ST segment concordance is seen.
- 21. TRICYCLIC ANTIDEPRESSANT INGESTION • Early ECG findings in tricyclic overdose includes Sinus tachycardia QRS complex widening >100ms Right axis deviation Characteristic R wave change in aVR. • Increase amplitude of terminal R wave . • Increased R to S ratio. • QTC prolongation due to QRS widening. • Progressive QrS widening has high risk for torses de pointus.
- 22. MALPOSITION AND TECHNICAL ERRORS DEXTROCARDIA • Major axis points to right ,hence P and QRS in aVR would be positive. •Non progression of R wave in left side leads. •Progression in right side leads. DEXTROVERSION /SHIFTING MEDIASTINUM •Heart is pushed to right with the chambers in the normal position. •aVR shows negative P and qRS. •Nonprogession of R from v1 to v6.
- 24. TECHNICAL DEXTROCARDIA •RA and LA is reversed. •aVR shows positive P wave and QRS. •Normal r wave progression. TENSION PNEUMOTHORAX ECG changes for left pneumothorax is common with and without tension includes Right axis deviation low voltage QRS Reduced precordial R wave voltage Anterior T wave inversion PR segment elevation in inferior leads Reciprocal PR segment depression in aVR
- 26. ACUTE PULMONARY EMBOLISM •Patient usually present with sinus tachycardia. •It may also give rise to arrythmia,alternation in conduction,shift in axis,ST segment and T wave asa well as S1Q3T3 pattern. • Acute RV overload couyld also manifest as ST elevation inaVR and terminal R wave.
- 28. PREDICTIVE VALVE OF ST ELEVATION IN aVR •ST elevation aVR > or equal to 1mm -->proximal LAD/LMCA occlusion. •ST elevation inaVR > or equal to v1 differentiates LMCA occlusion . •Absence of ST elevation aVR excludes significant LMCA lesion.
- 29. POTENTIAL CLINICAL SIGNIFICANCE OF aVR •LMCA occlusionSTE >1.5mm •Acute pericarditis PR elevation. •Acute TCA poisoni9ng prominent terminal R wave. •WPW ST segment elevation.