AVR ST elevation


  • AVR elevation is commonly thought of as a sign of Left Main Coronary Artery (LMCA) occlusion. However, STE 0.5mm or greater in lead aVR to be present in 78% of patients with and 14% of patients without LMCA stenosis.[1]
  • Use > 1mm and the clinical status of a patient if activating the cath lab based on aVR and concern for a STEMI

Clinical Features

Differential Diagnosis

ST Elevation


Isolated elevation AVR is poorly specific for a LMCA. The following are other causes of aVR elevation:

  • Nontraumatic thoracic aortic dissection
  • Massive Pulmonary Embolism
  • Massive GI bleed
  • Left bundle branch block (LBBB)
  • Left Ventricular Hypertrophy (LVH) with Strain Pattern
  • Severe atrial tachydysrhythmias
  • A chronic elevation without clinical significance


External Links


  1. Kosuge M et al. Predictors of Left Main or Three-Vessel Disease in Patients Who Have Acute Coronary Syndromes with Non-ST-Segment Elevation. Am J Cardiol 2005; 95: 1366 – 9. PMID: 15904646