Key result
Shark-fin ECG pattern in aVR signals acute total left main coronary artery occlusion.
Why the study?
The shark-fin ECG pattern is a rare but serious sign often suggestive of proximal LAD or LMCA involvement, with limited data on its presentation in the aVR lead as a first manifestation of acute LMCA occlusion.
Case Report (n=1)
The rare 'shark-fin' ECG pattern in the aVR lead is a critical marker for acute left main coronary artery occlusion that requires immediate recognition and emergent reperfusion.
Raises suspicion for left main occlusion in shock with aVR shark-fin; leaves open prospective validation before routine adoption.
BACKGROUND: "Shark-fin" is a rare but serious electrocardiogram (ECG) pattern often suggestive of proximal left anterior descending or left main coronary artery (LMCA) involvement. CASE SUMMARY: A 66-year-old man came to our hospital for acute chest pain and cardiogenic shock. ECG showed a shark-fin waveform in aVR lead along with diffuse ST-segment depression. Urgent coronary angiography demonstrated complete thrombotic LMCA occlusion and primary percutaneous coronary intervention with stent implantation allowed for hemodynamic stabilization and ECG normalization. DISCUSSION: Shark-fin is one of a series of patterns described as "ST-segment elevation myocardial infarction equivalent." It usually affects the anterior leads, expressing a left anterior descending artery critical lesion or occlusion. Here, the presence of this sign in the aVR lead was associated with LMCA acute, total, occlusion and a rapid diagnosis was crucial to enable the most appropriate treatment. TAKE-HOME MESSAGES: Shark-fin sign is an "ST-segment elevation myocardial infarction equivalent" pattern. When involving the aVR lead, it should raise immediate suspicion for LMCA occlusion. Rapid recognition and emergent reperfusion can be lifesaving.
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D'ascoli et al. (2026) conducted a case report in Acute Left Main Coronary Artery Occlusion (n=1). Shark-fin ECG pattern in aVR lead was evaluated on Angiographic diagnosis and clinical course. The presence of a shark-fin ECG pattern in the aVR lead was indicative of an acute, total occlusion of the left main coronary artery, underscoring its critical value for initiating immediate reperfusion.
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