Aneurysm Ischemia Ultrasound 
Dr. Smith's ECG Blog
OCTOBER 26, 2010
One very useful adjunct is ultrasound: Echo of his heart can distinguish aneurysm from acute MI by presence of diastolic dyskinesis, but it cannot distinguish demand ischemia from ACS. Furthermore, notice the well-formed Q-waves in inferior leads. These must raise suspicion of old MI with persistent ST elevation.
Dr. Smith's ECG Blog
JUNE 18, 2011
1.196 x STE60 in V3 in mm) + (0.059 x computerized QTc) - (0.326 x RA in V4 in mm) Third, one can do an immediate cardiac ultrasound. The old ECG has a Q-wave with persistent ST elevation in lead III, and some reciprocal ST depression (typical for aneurysm morphology). LV aneurysm is very different for inferior vs. anterior MI.
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. Beware a negative Bedside ultrasound.
Dr. Smith's ECG Blog
SEPTEMBER 16, 2015
An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." A bedside ultrasound was done by the emergency physician, using Speckle Tracking. What do you think? Unfortunately, that video is unavailable.
Dr. Smith's ECG Blog
JANUARY 6, 2023
I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. A CT was completed to rule out dissection, PE, or aneurysm, and this was unremarkable. mg/dL, K 3.5 Another 162mg ASA and heparin were given at this point.
Dr. Smith's ECG Blog
APRIL 3, 2019
You might think it is "Old MI with persistent ST Elevation" (otherwise known as "LV aneurysm" morphology.") That is a reasonable thought, but we have shown that if there is one lead of V1-V4 with a T/QRS ratio greater than 0.36, then it is STEMI, not LV aneurysm. These ultrasounds confirm LAD occlusion. What's the story?"
Dr. Smith's ECG Blog
APRIL 8, 2015
Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Evidence of acute ischemia (may be subtle) vii. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Left BBB vi. LVH or RV d.
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