THE ELECTROCARDIOGRAPHIC CLUE TO VENTRICULAR ANEURYSM

Abstract

Ventricular aneurysm, an occasional sequel to a very common disease, is frequently associated with the ecg. appearance usually interpreted as evidence of acute myocardial infarction. But with ventricular aneurysm this appearance is noted over an unduly protracted period. In only 1 of the 10 cases reported was acute infarction associated with ventricular aneurysm at autopsy. In the present study the ecg. finding of persistent S-T displacement was noted more frequently than other ecg. changes described as occurring with ventricular aneurysm. Although nonspecific, this finding should lead to the suspicion of the existence of ventricular aneurysm. The mechanism of this phenomenon is unknown. In the great majority of cases the Q-T interval was not prolonged; this is indirect evidence against ischemia as a cause of this phenomenon. Clinical and pathologic evidence is most consonant with Gordon Myers'' opinion that the appearance represents the endocardial aspect of activation of a hypertrophied left ventricular wall transmitted through the aneurysm. 7 of 10 autopsied cases showed a chronic inflammatory reaction in the pericardium overlying the aneurysm. The relation of this change or the electrical contribution made by the remaining muscle elements in the aneurysmal wall to the ecg. appearance are unknown.