Key result
ST elevation in ECG lead aVR during exercise stress testing successfully identified iatrogenic ostial left main coronary artery stenosis in a patient two months post-angioplasty.
Case Report (n=1)
ST elevation in lead aVR during stress testing is a useful sign for recognizing left main coronary artery stenosis, including iatrogenic cases post-angioplasty.
May flag iatrogenic left main stenosis on post-angioplasty stress testing; hypothesis-generating and requires prospective validation.
A 60-year-old diabetic male underwent a diagnostic coronary angiogram followed by angioplasty of the left circumflex coronary artery. Two months after the procedure, he presented with atypical chest pain and exercise stress testing done revealed ST elevation in lead aVR and ST depressions in multiple leads at 5.7 METS. Coronary angiogram done revealed ostial stenosis of the left main coronary artery, which in this case was attributed to an occult injury during the angioplasty procedure. ST elevation in lead aVR during stress testing is a neglected yet useful sign for recognition of LMCA stenosis as is illustrated in this case.
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Raghu et al. (2013) conducted a case report in Iatrogenic ostial left main coronary artery stenosis (n=1). Exercise stress testing with ECG lead aVR monitoring was evaluated on Recognition of left main coronary artery (LMCA) stenosis. ST elevation in ECG lead aVR during exercise stress testing successfully identified iatrogenic ostial left main coronary artery stenosis in a patient two months post-angioplasty.
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