STE in aVR, not always an ACS.

STE-aVR-ostial-LAD-thrombusCause by global ST depression especially at lead II and V5 – represent global subendocardial ischemia

What is causing the global subendocardial ischemia?

  • ACS -LMCA, proximal LAD, 3 vessel disease
  • Non ACS – more common. Cause by global myocardial strain from a Non-ACS etiology! (profound
  • sepsis, tachycardia, anemia, hypoxemia, etc)

So which one I’m dealing with?

  1. The key to determining the etiology is through history, physical exam, clinical picture, laboratory data, Echo, and vigilant monitoring and frequent reassessment.
  2. Identified and addressed potentially reversible causes of the ischemia, if the ECG pattern persists then you are dealing with ACS until proven otherwise.


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