Ventricular Tachycardia with ST Elevation in Lead aVR Associated with Normal Coronary Arteries: A Case Report and Review of Literature

As per the 2013 guidelines of ACCF/AHA (American College of Cardiology Foundation/ American Heart Association), ST Elevation (STE) in lead augmented vector right (aVR), along with ST depression in multiple leads, is associated with critical stenosis of left main coronary artery (LMCA), left anterior descending artery (LAD) or a triple vessel disease (TVD). Early identification of ST-Elevation Myocardial Infarction (STEMI) is important as timely reperfusion with intervention can save myocardium and improve survival. We present a case of a 70 years old female, with cardiovascular risk factors, who presented to the emergency department with chest pain decompensating with ventricular tachycardia. On cardioversion, she was found to have ST elevation in aVR with ST depression in V4-V6, I, II, and aVL. However subsequent echocardiogram and coronary angiogram showed normal coronary arteries and left ventricular function.