A proximal Left Anterior Descending (LAD) occlusion can cause widespread ST depression and ST elevation in aVR, but unlike with a left main occlusion, the ST elevation in aVR and V1 are of similar height.See also: ST depression and ischemia
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This ECG is from a woman in her 70s who presented with central chest pain. This was the initial ECG.
This ECG shows ST elevation in V1-2 with ST depression in V4-6 as well as I, II and aVF. R wave progression is also poor. V1 is concerning for a hyperacute T wave. The chest pain worsened and the ECG changes evolved to meet STEMI criteria. Troponin was elevated. Catheterisation found a 100% proximal LAD occlusion.