Letter by Jin-shan and Xue-bin Regarding Article, “Acute Coronary Syndrome: What Is the Affected Artery? Where Is the Occlusion Located? And How Important Is the Myocardial Mass Involved?”
To the Editor:
We read with great interest the case presented by Fiol-Sala and Bayés de Luna1 about identification of lesion location in acute anterior myocardial infarction. In this case, the authors proposed that if it were proximal occlusion of the long left anterior descending artery (LAD), then an upward injury vector would be produced and ST-depressions in leads II, III, and VF would appear. In contrast, if it were distal occlusion of the LAD, then a downward injury vector would be produced and ST-elevations in leads II, III, and VF would be recorded. We present another method for the lesion location in acute occlusion of LAD with lead VL. Lead VR has been widely used in identifying the culprit artery in acute coronary syndrome, but lead VL is not used a lot. It is just like an eye watching the heart from the left shoulder. In acute occlusion of LAD, if it is proximal, then the injury vector is upward and leftward, which is in parallel with the direction of VL, and ST-elevation will be recorded in it. In contrast, if the occlusion is distal, then the injury vector is downward and leftward, which produces an obtuse angle with VL, so ST-depression will appear. This is an easier method to identify the lesion location in acute occlusion of LAD, and we hope it can be validated in more research.
- © 2018 American Heart Association, Inc.