Chest pain and ST Elevation.

 A 42 year old presented with chest pain.  Here is his triage ECG:What do you think?' This is a classic pattern of ST Elevation that everyone should recognize.  There are QS-waves in V1-V4, with slight ST elevation in V1-V3.  (QS-wave means a Q-wave with no R-wave at all, in contrast to a QR-wave or qR-wave).  This is" Left Ventricular Aneurysm (LVA) " morphology and is due to Old Completed (Transmural) Anterior MI, which often results in an LV aneurysm and manifests on the ECG as " persistent ST elevation after old MI. "The T-wave may be upright or inverted.  See 2 examples below.In either case,  LVA has asmall T-wave (small upright or small inverted --not tall/wide nor inverted and deep/wide).  In any case, an inverted T-wave should tell you that the artery is not acutely and persistently occluded, unless it is a completed transmural OMI.  If the T-wave is upright, then occlusion is possible, but the significance of an upright T-wave depends on itssize relative to the QRS: We have developed aformula for differentiating acute anterior OMI from Old or Subacute anterior MI, which I discuss below. This patient had a cardiac POCUS in the ED (here is parasternal long axis):On the far left, see the out-pouching of the apex, especially with every systolic beat. This is a left ventricular aneurysm.Review of the chart revealed history of large MI, subsequent heart failure, and a previous identical ECG and...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs