What lead is the most overlooked on the EKG?
Answer: aVR
Lead aVR can provide some unique insight into 5 different conditions:
- Acute MI
- Pericarditis
- Tricyclic antidepressant (TCA) and TCA-like overdose
- AVRT in narrow complex tachycardias
- Differentiating VT from SVT with aberrancy in wide complex tachycardias by using the Vereckei criteria (possibly better than Brugada criteria)
It turns out that the aVR lead provides a lot of great information!
PV Card: Lead aVR on EKG
Adapted from 1–4
Go to the ALiEM Cards site for more resources.
See also:
1.
Williamson K, Mattu A, Plautz C, Binder A, Brady W. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006;24(7):864-874. [PubMed]
2.
Vereckei A, Duray G, Szénási G, Altemose G, Miller J. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5(1):89-98. [PubMed]
3.
Kireyev D, Arkhipov M, Zador S, Paris J, Boden W. Clinical utility of aVR-The neglected electrocardiographic lead. Ann Noninvasive Electrocardiol. 2010;15(2):175-180. [PubMed]
4.
Riera A, Ferreira C, Ferreira F, et al. Clinical value of lead aVR. Ann Noninvasive Electrocardiol. 2011;16(3):295-302. [PubMed]