ECG
Persistent characteristic ST elevation after MI
Non-specific ST segment changes
Q or QS waves
T waves small relative to QRS
No reciprocal changes
CXR
Prominent<unk>  heart border
Calcified aneurysm
May have mass-like appearance
TTE
LV angiography
Cardiac MRI
Persistent characteristic ST elevation after MI
Non-specific ST segment changes
Q or QS waves
T waves small relative to QRS
No reciprocal changes
Prominent<unk>  heart border
Calcified aneurysm
May have mass-like appearance
Differentiate<unk>  from STEMI and other causes of ST-elevation
Strongly suspect STEMI if:
Symptomatic
No q waves present (LV aneurysm typically produces significant q waves)
Evolving changes on serial ECG
Reciprocal changes
Consider two rules to differentiate
Rule 1
If (Sum of T-wave amplitudes in V1-V4) divided by (Sum of QRS amplitudes in V1-V4) > 0.22
Suggestive of STEMI, with ~87% accuracy
Rule 2
If any lead in V1-V4 has T-wave amplitude to QRS amplitude ratio > 0.35
Suggestive of STEMI, with ~89% accuracy
Symptomatic
No q waves present (LV aneurysm typically produces significant q waves)
Evolving changes on serial ECG
Reciprocal changes
Rule 1
If (Sum of T-wave amplitudes in V1-V4) divided by (Sum of QRS amplitudes in V1-V4) > 0.22
Suggestive of STEMI, with ~87% accuracy
Rule 2
If any lead in V1-V4 has T-wave amplitude to QRS amplitude ratio > 0.35
Suggestive of STEMI, with ~89% accuracy
If (Sum of T-wave amplitudes in V1-V4) divided by (Sum of QRS amplitudes in V1-V4) > 0.22
Suggestive of STEMI, with ~87% accuracy
If any lead in V1-V4 has T-wave amplitude to QRS amplitude ratio > 0.35
Suggestive of STEMI, with ~89% accuracy

>6mm limb leads
>10mm precordial leads

0.1mV in two or more contiguous leads
Left ventricular aneurysm
Cardiac
Left ventricular pseudoaneurysm
ST-segment elevation myocardial infarction 
Coronary artery dissection
Post-MI 
Nontraumatic thoracic aortic dissection
Previous MI with recurrent ischemia in same area