We have read with great interest the article recently published by Williamson et al entitled “ Electrocardiographic applications of lead aVR” [1], which addressed the findings of lead aVR regarding 4 important conditions, including acute coronary syndrome with left main coronary artery occlusion, acute pericarditis, significant tricyclic antidepressant poisoning, and Wolff-Parkinson-White syndrome. From medical literature review and our experience, we would like to mention 3 additional conditions that might present with electrocardiographic changes in lead aVR: dextrocardia, tension pneumothorax, and pulmonary embolism.