Friday, November 18, 2011

Paucis Verbis: The aVR lead on EKG

What lead is the most overlooked on the EKG? 
aVR


Lead aVR can provide some unique insight into 5 different conditions:
  1. Acute MI 
  2. Pericarditis 
  3. Tricyclic antidepressant (TCA) and TCA-like overdose 
  4. AVRT in narrow complex tachycardias 
  5. Differentiating VT from SVT with aberrancy in wide complex tachycardias by using the Vereckei criteria (possibly better than Brugada criteria)
It turns out that aVR provides a lot of great information!


You can download this PV card:  [MS Word] [PDF]
See other Paucis Verbis cards.
See also:
References
  • Kireyev D, Arkhipov MV, Zador ST, Paris JA, Boden WE. Clinical utility of aVR-The neglected electrocardiographic lead. Ann Noninvasive Electrocardiol. 2010 Apr;15(2):175-80. .
  • Riera AR, Ferreira C, Ferreira Filho C, Dubner S, Barbosa Barros R, Femenía F, Baranchuk A. Clinical value of lead aVR. Ann Noninvasive Electrocardiol. 2011 Jul;16(3):295-302. .
  • Vereckei A, Duray G, Szénási G, Altemose GT, Miller JM. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008 Jan;5(1):89-98. .
  • Williamson K, Mattu A, Plautz CU, Binder A, Brady WJ. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006 Nov;24(7):864-74. .
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2 comments:

  1. I am an aVR fan, too. On your card, I would say "TCA or 'TCA-like'". When I was a fellow such a long long time ago, I would often get seasoned MDs on the other line say, "Gee. This really LOOKS like a TCA poisoning, but they're not on a TCA!" Surprise! TCAs came back like ninjas, masquarading as other drugs (sort of).

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  2. @SFTox: Good catch. Thanks for reading the cards so carefully. I understand that there are some cases of cocaine causing TCA-like effects, because of the similar sodium channel blocking effects. Changed the card accordingly.

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