Question 10.2

This is the preoperative ECG of a patient.  There has been no recent chest pain or enzyme rise. What are the prominent features of this ECG? (Photo supplied on the next page)

What is the most likely diagnosis based on the ECG?

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College Answer

SR at 75/min, normal axis, LVH, Qwaves in Vl-V3, ST elevation antleads (Vl-V4), inv T I, flattened T waves V4-V6)

LV aneurysm, old ant MI +1- new silent MI???


My hat is off to the college for providing the exam ECG for future generations of trainees.

The definition of LV aneurysm is persisting ST elevation after an MI. We know that the patient has no current MI (the college tells us so). And we know that a previous MI took place (just look at those Q waves). The ECG changes are characteristic.



Rosenberg, Benjamin, and William J. Messinger. "The electrocardiogram in ventricular aneurysm.American heart journal 37.2 (1949): 267-277.

Nordenfelt, O. L. O. F. "The electrocardiogram in chronic aneurysm of the heart." Acta med. scandinav 102 (1939): 101.