Case Presentation: A 33 year old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-depression. An emergent catheterization was performed which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications.
\nDiscussion: Previous guidelines suggested that ST-elevation with diffuse ST-depression should be treated as a STEMI-equivalent involving the left-main or proximal left anterior descending coronary artery. However recent data suggests that the majority of these cases may not involve that territory. Regardless, this ECG finding should still be concern for acute coronary syndrome with the need for urgent catheterization.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Acute Coronary Syndrome; aVR; ST-elevation"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4601x21r","frozenauthors":[{"first_name":"Bruce","middle_name":"M","last_name":"Lo","name_suffix":"","institution":"Sentara Norfolk General Hospital/Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia","department":""},{"first_name":"Megyn","middle_name":"K","last_name":"Christensen","name_suffix":"","institution":"Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia","department":""},{"first_name":"Katherine","middle_name":"","last_name":"Schaffer","name_suffix":"","institution":"Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia","department":""},{"first_name":"Theodore","middle_name":"J","last_name":"Tzavaras","name_suffix":"","institution":"Sentara Norfolk General Hospital/Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia","department":""}],"date_submitted":"2024-09-05T23:14:29.217000Z","date_accepted":"2024-10-18T20:59:11.798000Z","date_published":"2024-12-18T00:45:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/35284/galley/31545/download/"}]}