He is followed after his anterior STEMI complicated by no-reflow and is discharged home. During a clinic follow-up visit 6 weeks later, the below ECG is obtained.
Which of the following is the correct diagnosis?
B. Normal ECG changes after an anterior myocardial infarction
C. Left ventricular aneurysm
D. Left bundle branch block
A left ventricular aneurysm can form after a STEMI. Most commonly, the apex of the heart is involved; however, the inferior wall can form an aneurysm as well. An LV aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring at least 6 weeks after a known transmural MI (usually anterior).
Without knowing a patient's past medical history, the ECG changes of an aneurysm may mimic an acute ST segment elevation MI. With an anterior or apical aneurysm, the persistent ST segment elevation is in lead V1 and V2. With an inferior aneurysm, it would be in lead II, III and aVF. The only way to be sure of an LV aneurysm diagnosis on an ECG (not from an acute MI) is to have the patient’s history of a prior heart attack and cardiac imaging to document the presence of an aneurysm.