The electrocardiographic pattern known as circumferential ischemia was described as a sign of left main coronary artery subocclusion or multivessel disease. However, newer studies question this angiographic association, although this sign is associated with higher in-hospital mortality.

Electrocardiographic Criteria

  • Diffuse ST-segment depression in 7 or more leads
  • ST-segment elevation in aVR and V1

ECG in Circumferential Ischemia

Electrocardiogram showing circumferential ischemia

Circumferential ischemia. Patient with chest pain that began a few hours earlier and an ECG showing diffuse ST-segment depression with ST elevation in V1 and aVR.

References

  1. Birnbaum Y, Bayés de Luna A, Fiol M, Nikus K, et al. Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report. J Electrocardiol. 2012;45(5):463–75.
  2. Alencar JN. Tratado de ECG. 2022.
  3. Harhash AA, Huang JJ, Reddy S, Natarajan B, et al. aVR ST Segment Elevation: Acute STEMI or Not? Incidence of an Acute Coronary Occlusion. Am J Med. 2019;132(5):622–30.