Dr. Smith's ECG Blog

JUNE 18, 2011

The old ECG has a Q-wave with persistent ST elevation in lead III, and some reciprocal ST depression (typical for aneurysm morphology). This rules out pericarditis, which essentially never has reciprocal ST depression. This is "Persistent ST elevation after previous MI" or "LV aneurysm morphology".

STEMI 52

STEMI Pericarditis Hospital Aneurysm 52

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

Normal RBBB, no evidence of ischemia. This may be permanent and may be associated with echocardiographic dyskinesis (aneurysm). LV aneurysm is common in completed, full thickness (transmural) MI, which is what we have here. Here is the patient's previous ECG (Figure 2): Previous ECG. R-waves of of normal height.

Aneurysm 52

Aneurysm Ischemia Embolism STEMI 52

Dr. Smith's ECG Blog

MARCH 11, 2016

More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. During the 48 hours of angina, such reversible ischemia often leads to myocardial stunning with akinesis of the myocardial wall that puts it at risk for thrombus. Re-occlusion 2.

Myocardial Infarction 52

Myocardial Infarction Pericarditis Angina STEMI 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Finally, coronary angiography was performed (at least 5 days after presentation) which confirmed LAD aneurysm with large thrombus burden, TIMI 0 flow, thrombectomy performed. Pericarditis? No further cath details available.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

MARCH 11, 2019

You do NOT see this in normal variant STE, nor in pericarditis. The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI.

Chest Pain 52

Chest Pain Ischemia Aneurysm Myocardial Infarction 52

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. These findings together are more commonly seen with pericarditis. There is some R wave in the lateral precordial leads.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89