The 12 Leads of Christmas: aVL

This article is the fourth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead. Lead aVL Today’s  review is going to be light (but heavy on EKG’s) on text to make room for tomorrow’s big post on aVR. It also helps that a lot of the principles that we discussed in yesterday’s post on lead III apply here as well. In summary: aVL is great for identifying STEMI’s (too!). In addition to lead III and V3, aVL is the third lead I usually choose to monitor for my patients who present with signs and symptoms concerning for ACS but no diagnostic changes on their initial 12-lead. The main reason I like aVL for this purpose is that it is the lead most reciprocal to lead III. As we just discussed, III is the lead that best shows ST-elevation or T-wave changes during most inferior STEMI’s, so being able to observe reciprocal ST/T-changes in aVL can help seal the diagnosis. Since inferior STEMI’s are much more common than isolated lateral STEMI’s, I use aVL to observe reciprocal changes a lot more often than I use it to directly spot ST-elevation. Obvious inferior STEMI. The T-wave inversion and ST-depression in aVL are a typical finding in that lead during inferior STEMI.   In another reference back to yesterday’s post, recall that the “injury vector” during inferior STEMI usually points in the 110–120 degree range in the fronta...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 12-Leads of Christmas 360 Degree Heart Original Articles Vince DiGiulio Source Type: research