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23-12: Left Ventricular Aneurysm

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

  • ST elevation in anterior contiguous leads

  • Deep pathologic Q waves in anterior leads

  • Absence of reciprocal changes

  • Loss of R waves

Pearls

  1. ST-segment elevation that occurs in the setting of an MI should resolve within days under normal circumstances. Persistent ST-segment elevation weeks or longer after MI is suspicious for ventricular aneurysm.

  2. A left ventricular aneurysm is a localized area of dyskinetic myocardium that bulges outward during both systole and diastole.

  3. Suspect an left ventricular 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.

FIGURE 23.12A

Left Ventricular Aneurysm. This ECG was obtained on an asymptomatic patient with history of MI 2 years prior. (ECG contributor: James V. Ritchie, MD.)

An E C G tracing with 12 leads from a patient with left ventricular aneurysm.
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FIGURE 23.12B

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

An E C G tracing with lead V 4 consists of a sharp dip and a curved peak, with irregular fluctuations in between. An arrowhead points to the right to the beginning of the dip. An arrow points up to the peak.
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