Aneurysm Article STEMI 
Dr. Smith's ECG Blog
JANUARY 27, 2024
Smith : Old inferior MI with persistent ST Elevation ("inferior aneurysm") has well-formed Q-waves. In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!). So this NSTEMI was likely a STEMI(-)OMI with delayed reperfusion. Deutch et al.
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
MAY 19, 2020
This is a troponin I level that is almost exclusively seen in STEMI. The patient's heart had significant recovery: Echo : Estimated LVEF 32%, apical wall motion abnormality with diastolic distortion (LV aneurysm), suggestive of old MI. So this is either a case of MINOCA, or a case of Type II STEMI. Troponin I rose to 44.1
Dr. Smith's ECG Blog
OCTOBER 26, 2011
Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. Cath showed a 95% LAD with flow. This was recorded 2.5
Dr. Smith's ECG Blog
DECEMBER 18, 2022
If you still have not read it, I strongly recommend that you read the following article on the diagnosis of "posterior" MI: Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia), by Meyers HP et al. His peak troponin was over 5000 ng/L.
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