Right precordial leads and lead aVR at exercise electrocardiography: does it change test results?

aVR - the forgotten lead

Electrocardiography continues to be a focal point of modern medicine, and the electrocardiogram (ECG) continues to be the most frequently ordered cardiac test. Most of the clinical importance of the ECG rests on the invaluable information it renders in diagnosing acute coronary syndromes and cardiac arrhythmias. However, the ECG is a valuable tool and diagnostic aid in the evaluation of many other conditions such as pericarditis and pulmonary embolism. Of the electrocardiographic leads, aVR has traditionally received less attention in clinical evaluation of the ECG. The present study discusses instances with pictorial examples in which lead aVR provides valuable clinical information and makes a case for close attention being paid to this 'forgotten lead'.