This is a perfect post by Dr Smith about this condition. Visit this link:
ECG features in LV aneurysm can include:
- Persistent ST elevation
- Sometimes, residual ST elevation in lateral leads with reciprocal ST depression in inferior leads can present (http://hqmeded-ecg.blogspot.my/2012/02/reciprocal-st-depression-in-ii-iii-avf.html)
- Flat or inverted T wave
- Loss of r wave/QS complex
- Fragmented QRS (which denotes high risk for VT/VF due to myocardial scarring)
- In the presence of LBBB, Chapman sign (notched R wave in lateral leads) and Cabrera sign (notched S wave in V3-V4)
Because of (1) and (2), sometimes it’s difficult to differentiate LV aneurysm vs LV aneurysm with acute occlusion.
For u who may not know, Dr Smith has created two formulas to differentiate LV aneurysm vs LV aneurysm with acute occlusion:
- Sum of T wave V1-4 / Sum of QRS voltage V1-4 > 0.22
- T/QRS ratio in any lead from V1-4 > 0.36
In this ECG, we can see
- Ratio in V3 and V4 clearly exceed 0.36
- Also presence of VPB in avL with q wave, R wave and concordant ST elevation.
So this is a LVA with acute occlusion.