You are in your outpatient clinic. A 64 year old male with history of DM II, HTN, Hyperlipidemia, CAD with recent lateral wall MI (1 month ago) is in your office for a follow up visit. He has no complaints, is compliant with his cardiac rehab and medications. He is currently "feeling great" and is able to perform daily activities with no SOB. Physical Exam is unremarkable, vital signs are well with in normal limits and screening labs are unremarkable. You order an EKG, and you find the following. WHAT DO YOU DO AND WHAT IS THE DX?

click here for better image ekg

What is of most concern in this EKG is the ST segment changes in leads v4-v6. If this patient where diaphoretic, suffering from angina or any other signs of MI we would be very worried about current infarction, how ever given the history of a recent lateral MI in the very near past, the fact that the patient is totally asymptomatic and no clinical signs are present of MI this represents persistants of ST elevation post MI secondarily to myocardial anuerysm. It is a common cause of this finding post MI. As a side not, there is no fear of the aneurysm bursting because the most dangerous time for rupture are with in the first 3-5 days post MI, after that the collegen is laid down thick enough that it is no longer an issue. However its presents make make those who dont know the history be quick to rush this man to the hospital. Echo also subsequently revealed a mild LV Aneurysm.