A left ventricular aneurysm (LV aneurysm) can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural MI (usually anterior). Without knowing the person's medical history, the ECG changes of an aneurysm may mimic an acute anterior myocardial infarction. With an anterior or apical aneurysm, the persistent ST elevation is in lead V1 and V2. In an inferior aneurysm it would be in lead II, III and aVF. The only way to be sure of an LV aneurysm diagnosis on an ECG (not from an acute MI) is to have the patient’s history of heart attack and cardiac imaging to document the presence of an aneurysm. The shape of the ST elevation is also relatively unique and has been described as “coving”.

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