A 55 year old man returns for routine follow up 6 weeks after an MI. He gets breathless when walking uphill. His ECG shows ST elevation in leads V1, V2, V3 and V4. What is the single most likely explanation for the abnormal investigation?

The key is D. Left ventricular aneurism. [Left ventricular aneurysm is defined as a localized area of myocardium with abnormal outward bulging and deformation during systole and diastole. Clinically, ventricular aneurysms may be recognized late with features of heart failure and persistent ST elevation. Risk factors for these aneurysms after acute MI include the following:

• Female sex

• Total occlusion of the left anterior descending (LAD) coronary artery

• Single-vessel coronary artery disease (CAD)

• Absence of previous angina pectoris].