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.
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This ECG is from a middle aged male who presented with a choking feeling in his throat, on a background of prior anterior STEMI complicated by cardiac arrest, and ICD.
This ECG shows QS waves with ST elevation in anterior leads. The T waves were larger than previous, so he was sent to the cath lab, but angiography was normal.