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Goldberger’s ECG sign in Left Ventricular Aneurysm

Sai Soundarya*

DNB Internal Medicine Resident, Kauvery Heart City, Trichy, India

Abstract

Ventricular aneurysm is a well-known complication post MI. The term aneurysm is used to describe dyskinesis or local expansile paradoxical wall motion. They are readily detected my two-dimensional echocardiography. But this case of ventricular aneurysm was picked by the classical ecg findings of ventricular aneurysm even prior to echocardiography.

Keywords: Goldberger’s sign, ventricular aneurysm

Case Presentation

A 51 years old patient, known to have diabetes mellitus and also known to indulge in alcohol was admitted with complaints of retrosternal chest pain and breathlessness on 13th December 2021.

On arrival he was tachypnoeic, with bilateral basal inspiratory crepitations.

Arrival ECG

ECG was suggestive of acute coronary syndrome, anterior wall acute myocardial infarction (AMI) with qRBBB pattern.

Echo revealed regional wall motion abnormality (akinesia involving the Left Anterior Descending Artery territory) with severe LV systolic dysfunction, and grade 2 diastolic dysfunction. No ventricular septal rupture, clot or pericardial effusion.

Since he could not afford primary PCI he was managed with thrombolysis, heparin, antiplatelets and statin along with other supportive measures.

Serial ECGs taken showed the persistence of ST elevation with additional findings of fractured QRS complexes, and R wave in lead aVR in the ECG taken 3 days post admission (15th December 2021).

The ECG finding of R wave in aVR was consistent with Goldberger’s sign of ventricular aneurysm [1].

Discussion

Left ventricular aneurysm (LVA) is a localised area of myocardium with abnormal outward bulging and deformation during both systole and diastole. The occurrence of LVA post MI is 3-15%

Risk factors

Female sex

Total occlusion of LAD

Single vessel disease

More than 80% of the anterolateral wall is affected in this context. Posterior and inferior walls are less commonly affected. The size of LVA range from 1-8 sq.cm

ECG changes in ventricular aneurysm:

Persistent ST segment elevation
Fragmented QRS complexes
Prominent R wave in aVR (Goldberger’s sign)

These changes are well illustrated in the ECG of this patient.

Reference

Goldberger E, Schwartz SP. Electrocardiographic patterns of ventricular aneurysm. Am J Med. 1948;4(2):243-47.

Dr. Sai Soundarya

DNB Resident

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