We just published this online in the American Journal of Emergency Medicine:
ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis
A couple ECGs: These do not come from the study:
This was a middle-aged man with chest pain (Figure A):
|There is diffuse ST elevation, but there is no ST depression in lead aVL|
The above is a case of a patient with chest pain who did not have MI. This was early repolarization.
Figure B. Here is a 40-something with chest pain
|What is it?|
The above (figure B) was a proven occlusion of an artery supplying the inferior wall (in this case, it was a distal occlusion of an LAD that wrapped around the apex and supplied the inferior wall.
Notice the minimal (less than 1 mm) ST elevation in III. But there is clearly some ST depression in aVL. This makes it all but diagnostic of inferior MI.
|What is this?|
Figure C above is proven pericarditis.
Here is the ECG 2 days later (Figure D):
Pericarditis later still