Paucis Verbis: The aVR lead on EKG

What lead is the most overlooked on the EKG? 

aVR

Lead aVR can provide some unique insight into 5 different conditions:

1. Acute MI 
2. Pericarditis 
3. Tricyclic antidepressant (TCA) and TCA-like overdose 
4. AVRT in narrow complex tachycardias 
5. Differentiating VT from SVT with aberrancy in wide complex tachycardias by using the Vereckei criteria (possibly better than Brugada criteria)

It turns out that aVR provides a lot of great information!

You can download this PV card:  [MS Word] [PDF]

See other Paucis Verbis cards.

See also:

• EM-RAP episode on ST elevation in aVR, featuring Amal Mattu nuggets of wisdom
• LifeInTheFastLane blog post on ST elevation in aVR

References

• Kireyev D, Arkhipov MV, Zador ST, Paris JA, Boden WE. Clinical utility of aVR-The neglected electrocardiographic lead. Ann Noninvasive Electrocardiol. 2010 Apr;15(2):175-80. .
• Riera AR, Ferreira C, Ferreira Filho C, Dubner S, Barbosa Barros R, Femenía F, Baranchuk A. Clinical value of lead aVR. Ann Noninvasive Electrocardiol. 2011 Jul;16(3):295-302. .
• Vereckei A, Duray G, Szénási G, Altemose GT, Miller JM. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008 Jan;5(1):89-98. .
• Williamson K, Mattu A, Plautz CU, Binder A, Brady WJ. Electrocardiographic applications of lead aVR. Am J Emerg Med. 2006 Nov;24(7):864-74. .