ECG abnormalities described in patients with Left Ventricular Aneurysm

1. Persistent ST segment elevation

Fragmented QRS complex

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.

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.

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ECG 2. 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.

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