Left Ventricular Aneurysm May Not Manifest as Persistent ST Elevation on Electrocardiogram

Patient: Male, 67 Final Diagnosis: Left Ventricular aneurysm post myocardial infarction Symptoms: Chest pain Medication: Dual antiplatelet therapy • anticoagulation Clinical Procedure: Cardiac catheterization Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Electrocardiographic presentations of left ventricle aneurysms are diverse; however, a persistent ST segment elevation post myocardial infarction is most commonly reported. CASE REPORT: The authors present a case of a 67-year-old man who presented to the emergency department after three days of chest pain and was found to have an acute myocardial infarction with an incidental finding of a left ventricular aneurysm. His surface electrocardiogram, however, demonstrated only inverted T waves in the precordial leads. He had a very elevated serum troponin I consistent with an acute myocardial injury which prompted a cardiac catheterization with angioplasty. Post angioplasty, he had persistent T wave inversions in the precordial leads. CONCLUSIONS: It is important for clinicians to appreciate that the presence of newly inverted T waves in patients with a late presentation post myocardial infarction should raise a concern for a possible left ventricular aneurysm.