Global Subendocardial Ischemia

Multilead ST-segment depression with ST-segment elevation in aVR is a pattern that has been recognized as a strong predictor of left main coronary artery or 3-vessel disease; however, occlusive coronary artery disease is not the only cause of this ECG pattern. Frequently, this pattern results from nonocclusive causes such as baseline left ventricular hypertrophy or conditions that create a supply-demand mismatch such as acute blood loss, sepsis, respiratory failure, tachydysrhythmias, and aortic stenosis. In one series of 133 patients showing this ECG pattern, only 28% had acute coronary syndromes, whereas 45% had hypertensive heart disease.



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