LV aneurysm or LV aneurysm with acute occlusion?

This is a perfect post by Dr Smith about this condition. Visit this link:

http://hqmeded-ecg.blogspot.my/2015/10/this-ecg-was-texted-to-me-last-night.html

ECG features in LV aneurysm can include:

  1. Persistent ST elevation
  2. 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)
  3. Flat or inverted T wave
  4. Loss of r wave/QS complex
  5. Fragmented QRS (which denotes high risk for VT/VF due to myocardial scarring)
  6. 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:

  1. Sum of T wave V1-4 / Sum of QRS voltage V1-4 > 0.22
  2. 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.

ED ECG QS-waves

So this is a LVA with acute occlusion.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s