ECG Surprise Attack!: Chest Pain and the “Forgotten Lead”

  • Nicholas S. Fern
  • Amal MattuEmail author


There are some ECG patterns that are not classically considered as ST-Segment Elevation Myocardial Infarctions (STEMIs) but represent what can be called STEMI equivalents as they portend significant potential for progression to infarctions. Though not recognized by many practitioners as an example of STEMI, the diagnostic utility of ST-segment-elevation (STE) in augmented Vector Right (aVR) has been recognized by various guiding international organizations. STE in aVR has proven association to multivessel coronary disease (MVD) and occlusions of the left main coronary artery (LMCA) and proximal left anterior descending (LAD) coronary artery.


ST elevation aVR STEMI equivalent Chest pain Left main coronary artery disease 


Disclosure Statement

The authors of this chapter report no significant disclosures.


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.The Queen’s Medical CenterHonoluluUSA
  2. 2.Department of Emergency Medicine, University of Maryland School of MedicineBaltimoreUSA

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