EKG of the Week 2018 10-7

This EKG comes courtesy of Dr. O’Halloran and Dr. Litvak.

A 74 year old female presents to the emergency department with Chest pain and SOB. She had an anterior wall STEMI 1 month prior and had stents placed. At the time of evaluation in the ED she is asymptomatic. Her EKG is below.

2018 10-7.jpg

 

1.    What does the EKG demonstrate?

2.    What can cause these EKG findings?

ANSWER:

The EKG shows ST elevations and Q waves in Leads V1-V6.

In the acute setting this would be consistent with an evolving anterior wall MI. One month after a STEMI, these findings can be caused a left ventricular aneurysm.

 

The EKG demonstrates ST elevations in leads V1-V6 with Q waves in the same leads. There are no reciprocal depressions. This pattern in a patient >2 weeks after a STEMI suggests a ventricular aneurysm. This is a potential complication of an MI. The most common location of a ventricular aneurysm is the anterior wall.

 

The patient had an echocardiogram which showed paradoxical movement of the left ventricular wall.

 

Patients with LV aneurysm are at risk for ventricular arrhythmias and sudden cardiac death.