Significance of lead aVR in acute coronary syndrome

The 12-lead electrocardiogram(ECG)is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome(ACS).Unlike other 11 leads,lead aVR has been long neglected until recent years.However,recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS.ST-segment elevation in lead aVR can be caused by(1)transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery;(2)transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery;and(3)reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads.On the other hand,ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions.It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction.Cardiologists should pay more attention to the tracing of lead aVR when interpreting the12-lead ECG in clinical practice.

Characteristics and outcomes of avoidant/restrictive food intake disorder in Japanese elementary-school students on total parenteral nutrition

The clinical outcomes of adolescents with avoidant/restrictive food intake disorder(ARFID)remain unclear.Furthermore,no report has compared the characteristics of ARFID and restricting-type anorexia nervosa(R-AN)in elementary-school students on total parenteral nutrition(TPN).This study retrospectively reviewed inpatients diagnosed with ARFID or R-AN between 2005 and 2019.Patients with ARFID(two boys and seven girls)and R-AN(13 girls)were hospitalized because of rapid physical deterioration,and nutrition therapy was continued without withdrawal.The ARFID group exhibited significantly lower body weights at admission than the R-AN group and gained an average of 6.5 kg during hospitalization;furthermore,the monthly weight gain during hospitalization was significantly higher,and no relapse was observed.Early physical improvement in ARFID resulted in good recovery.In conclusion,TPN can be easily introduced to patients with ARFID,in whom aversive eating is a concern,and is a suitable treatment for ARFID.