A 65-year-old man develops acute MI. Echocardiogram 3 days later shows a thin-walled left ventricular aneurysm with mural thrombus at the apex. Which ECG finding best correlates with this complication?
- A New right bundle branch block
- B Persistent ST elevation in precordial leads beyond 3–4 weeks ✓
- C ST depression in leads V4–V6 with tall R in V1
- D Bidirectional tachycardia
Correct answer: B. Persistent ST elevation in precordial leads beyond 3–4 weeks
Explanation
Persistent ST elevation beyond 3–4 weeks in precordial leads (typically V1–V4) is the classic ECG correlate of left ventricular aneurysm following anterior MI, reflecting dyskinetic myocardium with frozen ST segment. The aneurysm forms from ischaemic/infarcted myocardium that bulges with paradoxical motion during systole. New RBBB suggests proximal LAD occlusion affecting the right bundle but not aneurysm specifically. Bidirectional tachycardia is associated with digitalis toxicity or catecholaminergic polymorphic VT.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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