ECG Case 058

Elderly patient presenting with chest pain. Interpret the ECG.

ECG Ventricular Aneurysm

Describe and interpret this ECG


Main Abnormalities

This ECG shows changes consistent with an old anterolateral infarction — the so-called left ventricular aneurysm pattern.


The LV aneurysm pattern refers to the combination of residual ST elevation, deep Q waves and inverted or biphasic T waves seen in patients following an acute myocardial infarction. This ECG pattern is associated with transmural scarring and paradoxical movement of the LV on  wall on echocardiography.

Around 60% of patients with anterior STEMI develop some degree of chronic ST elevation on their ECG, which can cause diagnostic confusion.

If these patients present with chest pain, the safest approach is to take serial ECGs looking for signs of evolving STEMI such as evolving ST elevation or pseudo-normalisation of T waves.

TOP 100 ECG Series

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

One comment

  1. If the patient’s pain had resolved; could the vignette and ECG be interpreted as Wellens?

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