Augmented Vector Right ST-Segment Elevation: Pearls and Pitfalls

Published:January 21, 2021DOI:


      • Five clinical pearls for augmented vector right (aVR) ST-segment elevation (STE) are presented.
      • A mnemonic for differential diagnosis in nonocclusve aVR STE is discussed.
      • A brief review of the evolving literature on the high mortality rate associated with aVR STE is provided.


      ST-segment elevation myocardial infarction (STEMI) is characterized by ST-segment elevation in at least 2 contiguous leads, chest discomfort, and the release of biomarkers requiring emergent revascularization. In 2013, the American College of Cardiology Foundation/American Heart Association revised STEMI guidelines to include augmented vector right (aVR) ST-segment elevation to be treated as a STEMI equivalent. However, aVR ST-segment elevation with multilead ST depression can occur in presentations other than occlusive myocardial infarctions. The purpose of this clinical feature is to provide a brief review of aVR ST-segment elevation, explore approaches to clinical decision making, and provide tools to support nurse practitioners caring for patients with cardiac issues.


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      All authors are affiliated with the Department of Cardiac Sciences, Alberta Health Services in Calgary, Alberta, Canada. Jessica D. Jenkins, MN NP, is a nurse practitioner and can reached at [email protected] Margaret Henninger, MN NP, Mikaela J. Robertson, MN NP, Adrienne Rommens, MN NP, Lisa N. Wieler, MN NP, and Nancy M. Clark, MN NP, are nurse practitioners.