Aneurysm Angina STEMI 
Dr. Smith's ECG Blog
NOVEMBER 17, 2014
There were many comments that it was too late for thrombolytics or that this signified an LV aneurysm, not acute MI. See my formula for differentiating anterior LV aneurysm (that is to say, persistent ST elevation after old MI) from acute anterior STEMI. Both support acute anterior STEMI. It is not chronic. 3.0 = 0.50
Dr. Smith's ECG Blog
JUNE 18, 2011
This is a 45 yo male who had an inferior STEMI 6 months prior, was found to have severe LAD and left main disease, and was supposed to be set up for CABG a few weeks later, but did not follow up. But it could be anterior STEMI. 40% of anterior STEMI has upward concavity in all of leads V2-V6. is likely anterior STEMI).
Dr. Smith's ECG Blog
JULY 3, 2018
Despite ongoing chest discomfort and an uptrending troponin, he never meets STEMI criteria. The full thickness infarction with LV aneurysm morphology places him at a higher risk for short and long term complications (e.g., Free wall rupture, VSD, Dresslers Syndrome, chronic CHF, anatomic LV aneurysm, LV thrombus, stroke, etc).
Dr. Smith's ECG Blog
MARCH 11, 2016
A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." Perhaps she will not develop an LV aneurysm. hours when she called 911. LV Thrombus , 1.5
Dr. Smith's ECG Blog
FEBRUARY 26, 2025
When there are QS-waves, one should always think about LV aneurysm, but ST to QRS ratio and T-wave to QRS ratio are far too large and not compatible with left ventricular aneurysm. 50% of LAD STEMI have Q-waves by one hour. There is some R wave in the lateral precordial leads. Leads V3 and V4 both have 6mm ST elevation.
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