In this last case, which turned out to be myocarditis, the ST elevation in aVL was minimal due to very small QRS voltage in that lead.
Here is a similar aVL morphology, but this one was due to a Diagonal occlusion. Notice that the inferior ST depression is much more visible than the ST elevation:
There is also some ST depression in V3-V6 (and some STE in aVR), which should make one think of diffuse subendocardial ischemia. Unlike most cases of subendo ischemia, there is no ST depression in lead I. Thus, on limb leads, the ST axis is superior (not to the right). There is no left or right compnent on limb leads. However, on precordial leads, the ST axis would indeed appear to be to the right (away from the ST depression in V5 and V6).
Perhaps these leads were placed more anterior on the chest, and instead indicate more of a posteromedial ST axis, with some posterior MI.
Here is a similar aVL morphology, but this one was due to a Diagonal occlusion. Notice that the inferior ST depression is much more visible than the ST elevation:
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There is also some ST depression in V3-V6 (and some STE in aVR), which should make one think of diffuse subendocardial ischemia. Unlike most cases of subendo ischemia, there is no ST depression in lead I. Thus, on limb leads, the ST axis is superior (not to the right). There is no left or right compnent on limb leads. However, on precordial leads, the ST axis would indeed appear to be to the right (away from the ST depression in V5 and V6).
Perhaps these leads were placed more anterior on the chest, and instead indicate more of a posteromedial ST axis, with some posterior MI.
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