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t o r e g . c o m
Dr. Mete ALPASLAN
Left Ventricular Aneurysm (LVA) and the ECG
Definition
Left ventricular aneurysm (LVA): Balloon-like bulging of a part of LV myocardium which does not contract throughout the cardiac cycle.
Dyskinesis : A part of LV myocardium which contracts during diastole and relaxes during systole (paradoxical movement).
Myocardial infarction is the most common cause of ventricular aneurysm and dyskinesia.
Clinical significance of an LVA
Since aneurysm is a non-contracting part of the ventricle, it does not contribute to the cardiac output. The non-contracting aneurysm even steals some of the cardiac output produced by the contracting myocardial segments. Therefore, aneurysms are usually associated with heart failure.
Aneurysms are associated with cardiac arrhythmias.
Aneurysms may contain thrombus which may result in systemic embolization.
ECG abnormalities described in patients with LVA
1. Persistent ST segment elevation
2. Fragmented QRS complex
3. Prominent R wave in lead aVR (Goldberger sign)
The presence of above ECG findings are not pathognomonic for the presence of LVA.
Their presence may only suggest the presence of an LVA.
Absence of the above ECG abnormalities does not exclude the presence of LVA.
Persistent ST segment elevation
The well-known ECG sign of LVA is persistent (more than 2 weeks) ST segment elevation.
The ST segment elevation usually has a rounded
(domed) appearance.
Generally Q waves and negative T waves accompany the ST segment elevation.
Unlike acute ischemia, the ST segment elevation of LVA is persistent.
Unlike acute ischemia, reciprocal ST segment depression in other leads does not coexist.
However, the sensitivity and specificity of ST segment elevation in the diagnosis of LVA are poor. It has been reported that only 10% of the patients in the post-infarction setting with LVA exhibit a higher than 0.1 mV ST-segment elevation.
Persistent ST segment elevation is not specific to LVA. It may be seen in patients with LV dyskinesia, too.
Fragmented QRS complex
The presence in coronary patients with narrow QR or fractioned QRS morphologies (rSR' pattern or its variants), especially in II and V3-V6, has been considered a marker of LVA.
The specificity of these findings for LVA in patients with ischemic heart disease is very high (>90%), although its sensitivity is much lower (50%).
Right ventricular aneurysms may be seen in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
It has been reported that fragmented QRS complex predicts the arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
What happens to ST segment elevation after aneurysmectomy?
It has been reported that, after aneurysmectomy ST segment elevation
- remains unchanged in 61%
- improves in 26%
- becomes more pronunced in 13%
It has been suggested that the ST segment elevation does not originate in the injured myocardium adjacent to the LVA.
References
Eur Heart J 1994;15:1500-1504.
Am Heart J,1965;70:753-760.
Ann Noninvasive Electrocardiol 2006;11:132-138.
Brit Heart J 1969;31:357-364.
Brit Heart J 1970;32:440-448.
J Cardiovasc Electrophysiol 2013;24:1260-1266.
World J Cardiol 2014 April 26; 6(4): 154-174.
Am J Cardiol 1984;53:1542-1546.
J Electrocardiol 1984;17:75-77.
ECG 1. The ECG above is from an 89 years-old man who had experienced acute anterior myocardial infarction twice.
ECHOcardiography showed a very depressed left ventricle with an ejection fraction of about 15%, apical aneurysm and
mural thrombus. Anterior leads show Q waves and domed ST segment elevation.
Leads V4 to V6 also show negative T waves.
Lead aVR shows prominent R waves (Goldberger sign).
Leads II and III also show interatrial block.
Click here for a more detailed ECG
ECG 2. The compact ECG above belongs to a 44 years-old man with old inferior myocardial infarction.
His RCA and LAD arteries were stented at the time of the acute infarction.
Later, ECHOcardiography showed a large inferior LVA.
Leads II, III and aVF show Q waves, minimal ST elevation, negative T waves and fragmented QRS.
ECG 3. The ECG above belongs to a 41 years-old man with old anterior wall myocardial infarction.
Leads V3 and V4 show fragmented QRS. No typical ST segment elevation is seen.
ECHOcardiography showed apical LVA in this patient.
Absence of typical ECG findings do not exclude the possibility of a LVA.
Click here for a more detailed ECG
ECG 4.The compact ECG above belongs to a 66 years-old man with old anterior myocardial infarction.
ECHOcardiography showed apical LVA.
Leads V2 to V6 show domed ST elevation. Leads V3 to V6 also show negative T waves.
Fragmented QRS complexes in leads V4 to V6 suggest the presence of LVA.
ECG 5. The ECG above belongs to a 75 years-old woman who had experienced acute anterior myocardial infarction 8 years ago.
ECHOcardiography showed apical aneurysm.
Precordial leads show Q waves and ST segment elevation.
Fragmented QRS complexes, Goldberger sign and negative T waves are not seen in the above ECG.
Click here for a more detailed ECG
ECG 6. The ECG above belongs to a 59 years-old man who had experienced anterior wall myocardial infarction 7 years ago.
A recent ECHOcardiography examination showed aneurysm of the left ventricular apex and anterior septum.
Only the septal leads (V1 and V2) show ST segment elevation. Leads V2 to V6 show negative T waves.
Click here for a more detailed ECG
ECG 7. The ECG above belongs to a 49 years-old man with old anterior wall myocardial infarction.
Precordial leads show Q waves, ST elevation and negative T waves.
ECHOcardiography showed a large apical LVA.
Left ventricular systolic dysfunction was depressed and the ejection fraction was about 30%.
Click here for a more detailed ECG
ECG 8. The compact ECG above belongs to a 59 years-old man with old inferior wall myocardial infarction.
ECHOcardiography showed inferior LVA with an Ejection Fraction of about 38%.
Leads II, III and aVF show domed ST segment elevation, Q waves and fragmented QRS complexes.
ECG 9a. The ECG above belongs to a 71 years-old man who had experienced acute anterior myocardial infarction 8 years ago.
He has 3-vessel (extensive) coronary artery disease, including the left main coronary artery.
His initial clinical diagnosis was acute inferior myocardial infarction with minimal elevation of the cardiac enzymes.
The above ECG was recorded before the coronary artery bypass graft operation.
Leads II, III and aVF show Q waves, minimal ST elevation and negative T waves.
These leads also show fragmented QRS. ,
These findings may suggest the presence of LVA at first. However, ECHOcardiography did NOT show LVA in this patient.
Persistent (more than 2 weeks) and domed ST segment elevation is necessary for the ECG diagnosis of LVA.
Click here for a more detailed ECG
ECG 9b. The ECG above belongs to the same man. It was recorded 3 monhs after the coronary artery bypass graft operation.
A repeat ECHOcardiography examination did NOT show LVA.
Now, inferior leads show smaller q waves and upright T waves.
Only minimal ST segment elevation persists, but it is not domed.
This case shows that the sensitivity and specificity of ECG is not 100% in the diagnosis of LVA.
Click here for a more detailed ECG
ECG 10. The compact ECG above is from an 76 years-old man who had experienced acute inferior myocardial infarction.
He has 3-vessel (extensive) coronary artery disease. His RCA and Cx coronary arteries are totally occluded.
ECHOcardiography showed aneurysm of the inferior left ventricular wall, severe mitral regurgitation and
an Ejection Fraction of 35%.
Leads II, III and aVF show fragmented QRS complexes while the latter two also show negative T waves.
Lateral leads also show fragmented QRS complexes.
Neither ST segment elevation nor Goldberger sign are seen.
ECG 11. The ECG above belongs to a 69 years-old man with old anterior wall myocardial infarction.
His LAD and Cx coronary arteries were stented at the time of the acute infarction.
ECHOcardiography showed a large apical LVA with an Ejection Fraction of 25%.
Leads V1 to V3 show Q waves and ST segment elevation.
Some precordial leads also show negative T waves.
Click here for a more detailed ECG
ECG 12. The ECG above belongs to a 65 years-old man with old anterior wall myocardial infarction.
Leads C1 to C3 show ST segment elevation.
Leads C2 to C4 show fragmented QRS complexes.
ECHOcardiography showed apical LVA in this patient.
Click here for a more detailed ECG
ECG 13. The ECG above belongs to a 59 years-old man with old anterior myocardial infarction (12 years ago).
ECHOcardiography showed aneurysm of the anterior wall and the interventricular septum.
Intraventricular conduction defect is seen.
Domed ST elevation and fragmented QRS complexes are seen. The VPC also shows fragmentation.
Click here for a more detailed ECG
ECG 14. The ECG above belongs to a 72 years-old hypertensive man with old inferior myocardial infarction.
ECHOcardiography showed aneurysm of the basal portions of the inferior and posterior left ventricular walls.
Leads II, III and aVF show minimal domed ST segment elevation and negative T waves.
Fragmented QRS complexes (rSr' pattern) are seen in leads II and III.
Click here for a more detailed ECG
ECG 15. The ECG above belongs to a 70 years-old woman with old anterior wall myocardial infarction.
She had undergone coronary artery bypass graft operation for the LAD and Cx coronary arteries.
A recent ECHOcardiography examination showed apical aneurysm with an Ejection Fraction of about 40%.
Precordial leads show Q waves, leads V1 to V3 show domed ST elevation and negative T waves.
Lead V3 also shows fragmented QRS complexes.
Click here for a more detailed ECG
ECG 16. The ECG above belongs to a 58 years-old woman with old inferior wall myocardial infarction.
ECHOcardiography showed aneurysm of the inferior left ventricle.
Inferior leads have domed ST elevation, Q waves and negative T waves.
Click here for a more detailed ECG
ECG 17. The ECG above belongs to a 43 years-old man with old anterior wall myocardial infarction.
Precordial leads V4 to V6 show Q waves while leads V1 to V4 show domed ST elevation.
Leads V2 to V6 show negative T waves.
Leads V3 and V4 also show fragmented QRS complexes. rSr' pattern is seen in lead V3.
ECHOcardiography showed a large apical aneurysm and a left ventricular Ejection Fraction of about 30%.
Click here for a more detailed ECG
ECG 18. The ECG above belongs to a 61 years-old woman with old anterior wall myocardial infarction.
Her LAD artery was stented at the time of acute infarction.
Precordial leads V1 and V2 show Q waves while leads V1 to V3 show domed ST elevation and negative T waves.
ECHOcardiography showed apical aneurysm and a left ventricular Ejection Fraction of about 40%.
Click here for a more detailed ECG
ECG 19. The ECG above belongs to a 58 years-old man with old anterior wall myocardial infarction.
He had come to the hospital 6 hours after the onset of myocardial infarction
The Left Anterior Descending (LAD) coronary artery was totally occluded at its ostium.
He also had significant stenosis of the first Obtuse Marginal branch of the Circumflex coronary artery.
Ten months after the infarction, he now has a large left ventricular (LV) apical aneurysm with an Ejection Fraction of about 15%.
His ECG does not show typical ST segment elevation or QRS fragmentation, despite the presence of a large LV aneurysm.
Goldberger sign and evidence of left atrial abnormality are seen.
Click here for a more detailed ECG
ECG 20. The compact ECG above is from a middle-aged man who had experienced acute inferior myocardial infarction
5 months ago. Now, he has inferior wall pseudoaneurysm and 3rd degree (severe) mitral insufficiency.
Clinically he has heart failure. This ECG was recorded one day before he underwent a complex cardiac operation
(simultaneous mitral valve replacement, resection of the pseudoaneurysm and saphenous bypass graft to the RCA).
Fragmented QRS and domed ST elevation are seen in the inferior leads.
ECG 21a. The ECG above belongs to a 60 years-old man with old anterior wall myocardial infarction.
ECHOcardiography showed aneurysm of the anterior septum, interventricular septum and the left ventricular apex.
The myocardium in these regions were thinned, suggesting the development of myocardial scar.
Left ventricle was severely depressed with an Ejection Fraction of 20%.
Leads V2 to V6 show small q waves while leads V1 to V4 show ST segment elevation.
Also, leads V4 to V5 show fragmented QRS complexes.
Click here for a more detailed ECG
ECG 21b. Above is the compact ECG of the same patient.
ECG 22a. Above ECG is from a 64 years-old man. It was recorded just before his coronary artery bypass surgery.
Leads V1 to V3 show prominent Q waves. Lead V4 shows subtle q waves.
ECHOcardiography showed aneurysm of the left ventricular apex and the interventricular septum.
Domed ST elevation is seen in leads V1 and V2 (subtle in V2).
Click here for a more detailed ECG
ECG 22b. Above ECG is from the same patient. It was recorded at a calibration of 20 mm/mV.
At a calibration of 20 mm/mV, the domed ST elevation in lead V2 is seen easily.
Click here for a more detailed ECG
ECG 22c. Above is the compact ECG of the same patient.
ECG 23a. The ECG above is from a 75 years-old woman with old inferior wall myocardial infarction.
She had undergone coronary artery bypass grafting surgery in the past.
Inferior leads show Q waves, negative T waves and fragmented QRS complexes.
ECHOcardiography showed aneurysm of the left ventricular inferior wall.
Click here for a more detailed ECG
ECG 23b. Above is the compact ECG of the same patient (ECG 23a).
Note the fragmented QRS complexes.
Definition
Left ventricular aneurysm (LVA): Balloon-like bulging of a part of LV myocardium which does not contract throughout the cardiac cycle.
Dyskinesis : A part of LV myocardium which contracts during diastole and relaxes during systole (paradoxical movement).
Myocardial infarction is the most common cause of ventricular aneurysm and dyskinesia.
Clinical significance of an LVA
Since aneurysm is a non-contracting part of the ventricle, it does not contribute to the cardiac output. The non-contracting aneurysm even steals some of the cardiac output produced by the contracting myocardial segments. Therefore, aneurysms are usually associated with heart failure.
Aneurysms are associated with cardiac arrhythmias.
Aneurysms may contain thrombus which may result in systemic embolization.
ECG abnormalities described in patients with LVA
1. Persistent ST segment elevation
2. Fragmented QRS complex
3. Prominent R wave in lead aVR (Goldberger sign)
The presence of above ECG findings are not pathognomonic for the presence of LVA.
Their presence may only suggest the presence of an LVA.
Absence of the above ECG abnormalities does not exclude the presence of LVA.
Persistent ST segment elevation
The well-known ECG sign of LVA is persistent (more than 2 weeks) ST segment elevation.
The ST segment elevation usually has a rounded
(domed) appearance.
Generally Q waves and negative T waves accompany the ST segment elevation.
Unlike acute ischemia, the ST segment elevation of LVA is persistent.
Unlike acute ischemia, reciprocal ST segment depression in other leads does not coexist.
However, the sensitivity and specificity of ST segment elevation in the diagnosis of LVA are poor. It has been reported that only 10% of the patients in the post-infarction setting with LVA exhibit a higher than 0.1 mV ST-segment elevation.
Persistent ST segment elevation is not specific to LVA. It may be seen in patients with LV dyskinesia, too.
Fragmented QRS complex
The presence in coronary patients with narrow QR or fractioned QRS morphologies (rSR' pattern or its variants), especially in II and V3-V6, has been considered a marker of LVA.
The specificity of these findings for LVA in patients with ischemic heart disease is very high (>90%), although its sensitivity is much lower (50%).
Right ventricular aneurysms may be seen in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
It has been reported that fragmented QRS complex predicts the arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
What happens to ST segment elevation after aneurysmectomy?
It has been reported that, after aneurysmectomy ST segment elevation
- remains unchanged in 61%
- improves in 26%
- becomes more pronunced in 13%
It has been suggested that the ST segment elevation does not originate in the injured myocardium adjacent to the LVA.
References
Eur Heart J 1994;15:1500-1504.
Am Heart J,1965;70:753-760.
Ann Noninvasive Electrocardiol 2006;11:132-138.
Brit Heart J 1969;31:357-364.
Brit Heart J 1970;32:440-448.
J Cardiovasc Electrophysiol 2013;24:1260-1266.
World J Cardiol 2014 April 26; 6(4): 154-174.
Am J Cardiol 1984;53:1542-1546.
J Electrocardiol 1984;17:75-77.
ECG 1. The ECG above is from an 89 years-old man who had experienced acute anterior myocardial infarction twice.
ECHOcardiography showed a very depressed left ventricle with an ejection fraction of about 15%, apical aneurysm and
mural thrombus. Anterior leads show Q waves and domed ST segment elevation.
Leads V4 to V6 also show negative T waves.
Lead aVR shows prominent R waves (Goldberger sign).
Leads II and III also show interatrial block.
Click here for a more detailed ECG
ECG 2. The compact ECG above belongs to a 44 years-old man with old inferior myocardial infarction.
His RCA and LAD arteries were stented at the time of the acute infarction.
Later, ECHOcardiography showed a large inferior LVA.
Leads II, III and aVF show Q waves, minimal ST elevation, negative T waves and fragmented QRS.
ECG 3. The ECG above belongs to a 41 years-old man with old anterior wall myocardial infarction.
Leads V3 and V4 show fragmented QRS. No typical ST segment elevation is seen.
ECHOcardiography showed apical LVA in this patient.
Absence of typical ECG findings do not exclude the possibility of a LVA.
Click here for a more detailed ECG
ECG 4.The compact ECG above belongs to a 66 years-old man with old anterior myocardial infarction.
ECHOcardiography showed apical LVA.
Leads V2 to V6 show domed ST elevation. Leads V3 to V6 also show negative T waves.
Fragmented QRS complexes in leads V4 to V6 suggest the presence of LVA.
ECG 5. The ECG above belongs to a 75 years-old woman who had experienced acute anterior myocardial infarction 8 years ago.
ECHOcardiography showed apical aneurysm.
Precordial leads show Q waves and ST segment elevation.
Fragmented QRS complexes, Goldberger sign and negative T waves are not seen in the above ECG.
Click here for a more detailed ECG
ECG 6. The ECG above belongs to a 59 years-old man who had experienced anterior wall myocardial infarction 7 years ago.
A recent ECHOcardiography examination showed aneurysm of the left ventricular apex and anterior septum.
Only the septal leads (V1 and V2) show ST segment elevation. Leads V2 to V6 show negative T waves.
Click here for a more detailed ECG
ECG 7. The ECG above belongs to a 49 years-old man with old anterior wall myocardial infarction.
Precordial leads show Q waves, ST elevation and negative T waves.
ECHOcardiography showed a large apical LVA.
Left ventricular systolic dysfunction was depressed and the ejection fraction was about 30%.
Click here for a more detailed ECG
ECG 8. The compact ECG above belongs to a 59 years-old man with old inferior wall myocardial infarction.
ECHOcardiography showed inferior LVA with an Ejection Fraction of about 38%.
Leads II, III and aVF show domed ST segment elevation, Q waves and fragmented QRS complexes.
ECG 9a. The ECG above belongs to a 71 years-old man who had experienced acute anterior myocardial infarction 8 years ago.
He has 3-vessel (extensive) coronary artery disease, including the left main coronary artery.
His initial clinical diagnosis was acute inferior myocardial infarction with minimal elevation of the cardiac enzymes.
The above ECG was recorded before the coronary artery bypass graft operation.
Leads II, III and aVF show Q waves, minimal ST elevation and negative T waves.
These leads also show fragmented QRS. ,
These findings may suggest the presence of LVA at first. However, ECHOcardiography did NOT show LVA in this patient.
Persistent (more than 2 weeks) and domed ST segment elevation is necessary for the ECG diagnosis of LVA.
Click here for a more detailed ECG
ECG 9b. The ECG above belongs to the same man. It was recorded 3 monhs after the coronary artery bypass graft operation.
A repeat ECHOcardiography examination did NOT show LVA.
Now, inferior leads show smaller q waves and upright T waves.
Only minimal ST segment elevation persists, but it is not domed.
This case shows that the sensitivity and specificity of ECG is not 100% in the diagnosis of LVA.
Click here for a more detailed ECG
ECG 10. The compact ECG above is from an 76 years-old man who had experienced acute inferior myocardial infarction.
He has 3-vessel (extensive) coronary artery disease. His RCA and Cx coronary arteries are totally occluded.
ECHOcardiography showed aneurysm of the inferior left ventricular wall, severe mitral regurgitation and
an Ejection Fraction of 35%.
Leads II, III and aVF show fragmented QRS complexes while the latter two also show negative T waves.
Lateral leads also show fragmented QRS complexes.
Neither ST segment elevation nor Goldberger sign are seen.
ECG 11. The ECG above belongs to a 69 years-old man with old anterior wall myocardial infarction.
His LAD and Cx coronary arteries were stented at the time of the acute infarction.
ECHOcardiography showed a large apical LVA with an Ejection Fraction of 25%.
Leads V1 to V3 show Q waves and ST segment elevation.
Some precordial leads also show negative T waves.
Click here for a more detailed ECG
ECG 12. The ECG above belongs to a 65 years-old man with old anterior wall myocardial infarction.
Leads C1 to C3 show ST segment elevation.
Leads C2 to C4 show fragmented QRS complexes.
ECHOcardiography showed apical LVA in this patient.
Click here for a more detailed ECG
ECG 13. The ECG above belongs to a 59 years-old man with old anterior myocardial infarction (12 years ago).
ECHOcardiography showed aneurysm of the anterior wall and the interventricular septum.
Intraventricular conduction defect is seen.
Domed ST elevation and fragmented QRS complexes are seen. The VPC also shows fragmentation.
Click here for a more detailed ECG
ECG 14. The ECG above belongs to a 72 years-old hypertensive man with old inferior myocardial infarction.
ECHOcardiography showed aneurysm of the basal portions of the inferior and posterior left ventricular walls.
Leads II, III and aVF show minimal domed ST segment elevation and negative T waves.
Fragmented QRS complexes (rSr' pattern) are seen in leads II and III.
Click here for a more detailed ECG
ECG 15. The ECG above belongs to a 70 years-old woman with old anterior wall myocardial infarction.
She had undergone coronary artery bypass graft operation for the LAD and Cx coronary arteries.
A recent ECHOcardiography examination showed apical aneurysm with an Ejection Fraction of about 40%.
Precordial leads show Q waves, leads V1 to V3 show domed ST elevation and negative T waves.
Lead V3 also shows fragmented QRS complexes.
Click here for a more detailed ECG
ECG 16. The ECG above belongs to a 58 years-old woman with old inferior wall myocardial infarction.
ECHOcardiography showed aneurysm of the inferior left ventricle.
Inferior leads have domed ST elevation, Q waves and negative T waves.
Click here for a more detailed ECG
ECG 17. The ECG above belongs to a 43 years-old man with old anterior wall myocardial infarction.
Precordial leads V4 to V6 show Q waves while leads V1 to V4 show domed ST elevation.
Leads V2 to V6 show negative T waves.
Leads V3 and V4 also show fragmented QRS complexes. rSr' pattern is seen in lead V3.
ECHOcardiography showed a large apical aneurysm and a left ventricular Ejection Fraction of about 30%.
Click here for a more detailed ECG
ECG 18. The ECG above belongs to a 61 years-old woman with old anterior wall myocardial infarction.
Her LAD artery was stented at the time of acute infarction.
Precordial leads V1 and V2 show Q waves while leads V1 to V3 show domed ST elevation and negative T waves.
ECHOcardiography showed apical aneurysm and a left ventricular Ejection Fraction of about 40%.
Click here for a more detailed ECG
ECG 19. The ECG above belongs to a 58 years-old man with old anterior wall myocardial infarction.
He had come to the hospital 6 hours after the onset of myocardial infarction
The Left Anterior Descending (LAD) coronary artery was totally occluded at its ostium.
He also had significant stenosis of the first Obtuse Marginal branch of the Circumflex coronary artery.
Ten months after the infarction, he now has a large left ventricular (LV) apical aneurysm with an Ejection Fraction of about 15%.
His ECG does not show typical ST segment elevation or QRS fragmentation, despite the presence of a large LV aneurysm.
Goldberger sign and evidence of left atrial abnormality are seen.
Click here for a more detailed ECG
ECG 20. The compact ECG above is from a middle-aged man who had experienced acute inferior myocardial infarction
5 months ago. Now, he has inferior wall pseudoaneurysm and 3rd degree (severe) mitral insufficiency.
Clinically he has heart failure. This ECG was recorded one day before he underwent a complex cardiac operation
(simultaneous mitral valve replacement, resection of the pseudoaneurysm and saphenous bypass graft to the RCA).
Fragmented QRS and domed ST elevation are seen in the inferior leads.
ECG 21a. The ECG above belongs to a 60 years-old man with old anterior wall myocardial infarction.
ECHOcardiography showed aneurysm of the anterior septum, interventricular septum and the left ventricular apex.
The myocardium in these regions were thinned, suggesting the development of myocardial scar.
Left ventricle was severely depressed with an Ejection Fraction of 20%.
Leads V2 to V6 show small q waves while leads V1 to V4 show ST segment elevation.
Also, leads V4 to V5 show fragmented QRS complexes.
Click here for a more detailed ECG
ECG 21b. Above is the compact ECG of the same patient.
ECG 22a. Above ECG is from a 64 years-old man. It was recorded just before his coronary artery bypass surgery.
Leads V1 to V3 show prominent Q waves. Lead V4 shows subtle q waves.
ECHOcardiography showed aneurysm of the left ventricular apex and the interventricular septum.
Domed ST elevation is seen in leads V1 and V2 (subtle in V2).
Click here for a more detailed ECG
ECG 22b. Above ECG is from the same patient. It was recorded at a calibration of 20 mm/mV.
At a calibration of 20 mm/mV, the domed ST elevation in lead V2 is seen easily.
Click here for a more detailed ECG
ECG 22c. Above is the compact ECG of the same patient.
ECG 23a. The ECG above is from a 75 years-old woman with old inferior wall myocardial infarction.
She had undergone coronary artery bypass grafting surgery in the past.
Inferior leads show Q waves, negative T waves and fragmented QRS complexes.
ECHOcardiography showed aneurysm of the left ventricular inferior wall.
Click here for a more detailed ECG
ECG 23b. Above is the compact ECG of the same patient (ECG 23a).
Note the fragmented QRS complexes.