LV aneurysm

A left ventricular aneurysm causes persistent ST elevation 2 or more weeks after an acute infarction. On echocardiography there is paradoxical wall movement.

It can be difficult to tell apart LV aneurysm from re-infarction. An aneurysm is less likely to have dynamic or reciprocal changes and more likely to have a T:QRS ratio < 0.36 in all chest leads. An infarction is more likely to have ongoing chest pain and haemodynamic instability.

See also: STEMI Mimics

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References

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Anterior ST elevation Pathological Q waves LV aneurysm 12-Lead Dr Smith's ECG Blog CC BY-NC
Classic LV aneurysm (persistent ST elevation after previous MI)

This ECG is from a man in his 70s who presented with acute chest pain on a background of a recent CABG.

This ECG shows deep anterior Q waves suggesting an old infarct , with persistent ST elevation suggesting a left ventricular aneurysm.