Lead aVR Sign for Left Main / Proximal LAD Occlusion
ST elevation in lead aVR (especially ≥1 mm) with diffuse ST depression in ≥6 leads is a high-risk ECG pattern suggesting left main coronary artery or proximal LAD occlusion. Associated with high mortality.
Score interpretation
→ High-risk aVR pattern with instability: Likely left main occlusion or equivalent. Emergency cath lab activation; inotropic/vasopressor support; IABP; aspirin + P2Y12 loading; heparin; cardiac arrest team on standby. In-hospital mortality >40% without prompt revascularisation.
→ aVR elevation with diffuse ST depression: Highly suspicious for LM/proximal LAD occlusion or severe global ischaemia. Treat as STEMI equivalent; cath lab within 2 hours; dual antiplatelet; anticoagulation. Serial ECGs and troponins.
→ Mild or isolated aVR change. Consider: diffuse subendocardial ischaemia (demand), LBBB, LVH, tachyarrhythmia, PE, or myocarditis. Serial ECGs, troponins, echocardiogram. Cardiology review.
Interpretation bands for the aVR Sign. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Fridericia Corrected QT Interval (QTcF) · ECG Interpretation
- Modified Sgarbossa's Criteria (Smith Modification) for MI in LBBB · ECG Interpretation
- Brugada Phenocopy Score · ECG Interpretation
- Wellens Syndrome ECG Pattern · ECG Interpretation
- de Winter ECG Pattern for Proximal LAD Occlusion · ECG Interpretation
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Hydroxocobalamin (High-Dose — Cyanide Antidote) · Cyanide Antidote (Vitamin B12 Precursor at High Dose)
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.