ECG Strip 10
A woman with a positive cardiac history (heart attack few years ago) has been brought to our outpatient department by paramedics because of weakness, dizziness and repeated fainting. The ECG record shows normal sinus rhythm but some pathologic findings are visible. There is positive QRS amplitude in lead I and negative in leads II and III, which is a finding typical for LAFB. The QS QRS pattern in V1-V4 is typical for a myocardial scar (probably resulting from the above-mentioned heart attack). Much more disturbing is the elevation of ST segment located in leads V3 (best visible) and V4. These changes could occur in an acute STEMI infarction of the anterior wall. Cardiac enzymes are negative and the ST elevations are related to a heart aneurysm that has been confirmed by echocardiography.