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Saturday, May 27, 2017

Left Ventricular Aneurysm.- ECG

The ECG shown below was obtained in an asymptomatic patient with a history of myocardial infarction about 2 years ago.

                                           (click to enlarge)

ECG Findings
• ST elevation in anterior contiguous leads
• Deep pathologic Q waves in anterior leads

Clinical Pearls
1. ST segment elevation which occurs in the setting of a myocardial infarction should resolve within days under normal circumstances.
2. Persistent ST-segment elevation occurring for weeks or longer after a myocardial infarction is suspicious for ventricular aneurysm.
3. Ventricular aneurysms may follow a large myocardial infarction in the anterior portion of the heart.
4. The aneurysm consists of scarred myocardium, which does not contract but bulges outward during systole; complications include congestive heart failure, myocardial
rupture, arrhythmias, and thrombus formation.

5. Suspect an LV aneurysm when these findings appear in the ECG of a patient who does not demonstrate symptoms suggesting Acute Coronary Syndrome. However, one should also be vigilant
for the presence of “silent” Acute Coronary Syndrome

Persistent ST elevations (arrow) and deep, pathologic Q waves (arrowhead) in an asymptomatic patient with a history of anterior myocardial infarction 2 years earlier.

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