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This post is an answer to the ECG Case 225

• Rate: ~90 bpm
• Rhythm:
  • Regular
  • Sinus Rhythm
  • Last complex PVC
• Axis: LAD
• Intervals:
  • PR – Prolonged (220ms)
  • QRS – Normal (100ms)
  • QT – 320ms (QTc Bazette 380-400 ms)

• Segments:
  • ST elevation in leads III, V1-5
  • ST depression (minor) in lead I
• Additional:
  • Q wave in V1-2 
  • QS Wave in V3-4
  • T inversion in leads aVR, aVL
  • Voltage criteria LVH – aVR ~1.2mV

Interpretation:

ECG features stongly suggest an old anteroseptal MI, with Q / QS waves in precordial leads, a lack of significant ST depression, and a pain-free patient with a known previous ischaemic insult. This patient was admitted and investigated for dyspnea further with the following investigations:

Myocardial Perfusion Scan

• Large anteroseptal and apical infarction
• Small area of reversible ischaemia in the mid-to-basal anterior wall

Echocardiography

• Severely impaired systolic function
• Large anteroapical aneurysm
• No LV thrombus
• LV ejection fraction 27%

READ MORE: Know the Differential for ST Segment Elevation: It’s More Than Just ACS

SIMILAR CASES:

• ECG Case 170: Old Anterior MI with Left Ventricular Aneurysm
• ECG Case 76: Old anterior MI with a Left Ventricular Aneurysm
• ECG Case 65: Old Anterolateral MI with Left Ventricular Aneurysm