Sinal de El-Sherif - from Medscape

A 54-year-old man with history of previous myocardial infarction (MI) is seen by his cardiologist for follow-up. He has been complaining of occasional palpitations, which were discovered on Holter monitor to be runs of nonsustained ventricular tachycardia (VT).


Focusing on the precordial leads, which of the following cardiac structural abnormalities are suggested by the ECG to exist in this patient?

This patient, who has had a previous MI, is at risk for several post-MI complications, including dysrhythmias, congestive heart failure, mitral regurgitation, and ventricular wall rupture. Another such complication is ventricular aneurysm, which has developed in this patient. The QRS complexes are noted to be prolonged at 140 msec. In addition, the El-Sherif sign, which is an rSr' complex in the anterior precordial leads, is present in V4. This complex represents the depolarization current of the ventricle traveling around the aneurysm. Medical management includes arrhythmia management, the use of angiotensin-converting enzyme inhibitors, and monitoring for aneurysmal thrombus. If the left ventricular (LV) ejection fraction is below 35%, a prophylactic internal cardiac defibrillator should also be considered.

Answer: Ventricular Aneurysm