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Left ventricular aneurysm
Causes persistent ST elevation, > 2 weeks post MI
Most often seen in anterior MI, may also be inferior
Occurs due to scar formation and paradoxical wall movement
Causes
Post MI
Cardiomyopathy
Cardiac infection
Congenital
Clinical significance
May cause cardiomyopathy/CHF
Arrhythmogenic, may cause sudden cardiac death
Potential for thrombus formation, risk of thromboembolic stroke
KEY PEARLS:
KEY PEARLS:
Key causes of diffuse ST-segment elevation (especially on the boards)
STEMI/Vasospasm
Signs and symptoms of ACS, evolving ECG changes, reciprocal changes, ± Q waves
Pericarditis/Myocarditis
No Q waves, non-STEMI ST morphology, no reciprocal changes, PR segment depression
Early repolarization
No Q waves, concave ST morphology with J-waves, no reciprocal changes
Ventricular aneurysm
Has Q waves, no reciprocal changes, similar to old ECG
If you cannot explain ST elevation clinically, consider STAT echo in the ED to evaluate for other causes
LV aneurysm causes persistent ST elevation due to wall motion defect
LV aneurysms are clinically important high risk for arrhythmia, thrombus formation
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