Left main occlusion

Left main occlusion and stenosis are commonly confused. A Left Main Coronary Artery (LMCA) stenosis can cause widespread ST depression and ST elevation in aVR, but unlike with a proximal LAD occlusion, the ST elevation in aVR is greater than in V1. It is likely that many cases reported as left main occlusion with this pattern have sub-total occlusion (stenosis). A true occlusion has a high risk of cardiac arrest and may show widespread massive ST elevation with ST depression in aVR.

See also: ST depression and ischemia

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References

    ECG Library (17)

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    In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead ST elevation in aVR ST elevation in V1 Widespread ST depression Left main occlusion Dr Smith's ECG Blog CC BY-NC
    How does acute left main occlusion present on the ECG?

    This ECG is from a woman in her 50s who presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain.

    This ECG shows widespread ST depression with ST elevation in aVR and V1-2, due to a 100% left main occlusion.

    In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest Dyspnoea 12-Lead Anterior ST elevation Lateral ST elevation Sinus tachycardia LAFB RBBB Left main occlusion Dr Smith's ECG Blog CC BY-NC
    How does acute left main occlusion present on the ECG? Case 2

    This ECG is from a young woman who presented with sudden pulmonary oedema. This ECG was recorded just before she arrested.

    This ECG shows sinus tachycardia, RBBB, LAFB and ST elevation in V2-6, I and aVL. The cause was a 100% left main occlusion.

    In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Inferior ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
    Total eclipse of the heart

    This ECG is from This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation.

    In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Anterior ST elevation Bradycardia Inferior ST elevation Lateral ST elevation Normal Axis Regular Shark fin ST elevation Widespread ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
    Total eclipse of the heart – 40 min later with crushing chest pain

    This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG 40 min after arrival when he had a sudden recurrence of crushing chest pain and appeared critically ill.

    In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Electrode Detachment Serial 12-lead Anterior ST elevation Bradycardia Inferior ST elevation Lateral ST elevation Normal Axis Regular Shark fin ST elevation Widespread ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
    Total eclipse of the heart – 41 min later with crushing chest pain, just before arrest

    This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG about 41 min after arrival, with recurrent crushing chest pain, just before he arrested.

    In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Regular Short QRS Left main occlusion Dr Smith's ECG Blog CC BY-NC
    Total eclipse of the heart – after placement of LVAD

    This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG post-arrest after angiogram showing left main occlusion and placement of an LVAD.