Signs and symptoms of a ventricular aneurysm are closely related to the clinical presentation of an acute myocardial infarction (AMI) [1] [2]. In fact, up to 95% of all ventricular aneurysms are thought to occur in this patient population [3]. Other etiologies associated with this cardiac pathology are trauma, surgical interventions involving the heart, and infections, whereas their appearance as isolated congenital lesions has also been noted [3] [4] [5] [6] [7]. Despite the different types of aneurysms based on the degree of rupture (a true aneurysm involves the full thickness of the myocardium, while pseudoaneurysms are contained by the pericardial sac), patients present in a similar fashion [1] [2]. Interestingly, a large number of patients are asymptomatic and smaller aneurysms, in general, do not pose a significant risk to the patient [1] [2]. In approximately 60% of patients who are symptomatic, however, typical chest pain seen in MI may be reported, as well as dyspnea and hypotension accompanied by bradycardia [2] [6]. A pericardial friction rub is also observed, together with heart murmurs and an overall decrease in the intensity of heart sounds [2]. Unfortunately, symptomatic patients usually progress to heart failure and are at risk for aneurysmal rupture (which can be life-threatening), development of arrhythmias and insufficiency of the coronary arteries, thrombosis, bacterial endocarditis, and even death [6]. For this reason, an early diagnosis is crucial.

• Congestive Heart Failure

  heart failure Arrhythmias Peripheral embolization Usually are either true or false aneurysms True ventricular aneurysms Localized outpouching of ventricular cavity Associated with dyskinesia Wide-mouthed in connection with the LV Anterolateral or apical [learningradiology.com]

  Post-infarction LV-remodelling can be characterised by chamber dilatation and abnormal shape leading to systolic and diastolic dysfunction and, in the advanced form, to congestive heart failure. [cardiothoracicsurgery.org]

  Complications of ventricular aneurysm such as chronic congestive heart failure and rupture of the aneurysm were infrequent causes of death, and systemic embolic phenomena were not observed as a cause of death. [ahajournals.org]

• Large Pericardial Effusion

  We report a case of left ventricular aneurysm with a large pericardial effusion diagnosed at 17 weeks' gestation but retrospectively recognized on imaging at 15 weeks 6 days. [ucdavis.pure.elsevier.com]

  However, depending on their location and association with other anomalies, diverticula may trigger heart failure, arrhythmia, rupture, large pericardial effusion, and hydrops fetalis 1,2,5,6. [scielo.br]

  Figure 1 Two dimensional fetal echocardiography showed large thin-walled left ventricular aneurysm, 24 21 18 mm, originated from left ventricular free wall with large pericardial effusion and compressed the ipsi-lateral lung. [nature.com]

• Hepatosplenomegaly

  She had neither hepatosplenomegaly nor pretibial edema. Her peripheral pulses were normal, and she had no focal neurologic deficits. Her blood urea nitrogen was 29 mg/dl, and serum creatinine was 0.9 mg/dl. [ctsnet.org]

• Tachycardia

  Finally, after 9 days of persistent ventricular tachycardia, resection of the aneurysm was carried out with excellent eventual recovery and correction of ventricular tachycardia. [annals.org]

  On Holter ECG monitoring frequent PVC (26,333 beats/day; 24.7% of the total heart rate) and non-sustained ventricular tachycardia (NSVT) were noted ( Figure 1B ). [jstage.jst.go.jp]

  The patient's ventricular tachycardia (VT) was refractory to different treatments. Due to the presence of a ventricular thrombus, epicardial ablation was performed but the VT recurred. [ncbi.nlm.nih.gov]

  CLINICAL CASE A 49-year-old woman without a family history of heart disease with a background of paroxysmal supraventricular tachycardias for 17 years. [revespcardiol.org]

  Tachycardia is another finding. Cardiovascular Common findings in patients with LV aneurysm include: [1] Palpation Diffuse, sustained apical systolic thrust and a double impulse. Displaced apical impulse to the left of the mid clavicular line. [wikidoc.org]

• Heart Disease

  Rheumatic heart disease should be considered in HIV positive patients from endemic areas who have evidence of heart disease. [mjdrdypu.org]

  Pathogenesis of chronic Chagas heart disease. Circulation 2007;115:1109-23. 8. Bonney KM, Engman DM. Chagas heart disease pathogenesis: One mechanism or many? Curr Mol Med 2008;8:510-8. 9. Rossi MA. [heartviews.org]

  Braunwald's heart disease : a textbook of cardiovascular medicine. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455751341 . [wikidoc.org]

  From how ‘broken heart syndrome’ can also be triggered by happy events, to how cardiologists are now using 3D printing to personalise treatment for heart disease. [eurheartj.oxfordjournals.org]

  Stable ischemic heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia: Elsevier; 2015. pp. 1182–244. [ Google Scholar ] 8. [ncbi.nlm.nih.gov]

• Diminished Heart Sounds

  A personal history that reveals MI or recent surgery of the heart may be a useful piece of information, whereas auscultation of the heart (during which murmurs, bradycardia, and/or diminished heart sounds are revealed) might reveal crucial findings to [symptoma.com]

• Impulsivity

  Cardiovascular Common findings in patients with LV aneurysm include: [1] Palpation Diffuse, sustained apical systolic thrust and a double impulse. Displaced apical impulse to the left of the mid clavicular line. [wikidoc.org]

  Three months later, he presented with fatigue, a displaced point of maximal impulse, a holosystolic murmur, and a visually pulsatile abdomen above the umbilicus. [doi.org]

  Diagnosis A number of signs may indicate ventricular aneurysm, including an abnormal precordial impulse in the heartbeat, persistent elevation of the S-T segment of an electrocardiogram, and a characteristic bulge seen on the heart when x rayed. [medical-dictionary.thefreedictionary.com]

  During the surgery we performed epicardial EPhS with overdriving stimulation of 200 impulses a minute; VT was induced. [intechopen.com]

Imaging studies are necessary to make the diagnosis of a ventricular aneurysm. Still, the physician plays a key role in raising clinical suspicion toward a cardiac origin of signs and symptoms. A detailed patient history should cover the onset of symptoms and their progression. A personal history that reveals MI or recent surgery of the heart may be a useful piece of information [1], whereas auscultation of the heart (during which murmurs, bradycardia, and/or diminished heart sounds are revealed) might reveal crucial findings to make the initial diagnosis. As soon as sufficient evidence is raised, electrocardiography should be performed, but because a distinction between a true aneurysm and a pseudoaneurysm can't be made during this procedure (the importance lies in the somewhat different prognosis and treatment), direct imaging of the heart is necessary [1]. Cardiac ultrasonography (echocardiography) is a useful and noninvasive first-line study that provides very fast results but its ability to visualize an entire aneurysm and determine the exact physical characteristics is inferior, compared to computed tomography (CT) or magnetic resonance imaging (MRI) [1] [2] [4] [8]. Contrast-enhanced MRI is even more superior, as it allows for a complete evaluation of the myocardium and, thus, is able to differentiate a true aneurysm from a pseudoaneurysm [1].

• Mediastinal Mass

  Most likely vascular in origin, however mediastinal masses could not be ruled out. Case Report Figure 2: Organised thrombus removed from aneurysmal sac. A 63-year-old female presented with a large inferior myocardial infarction. [ctsnet.org]

• Inferior Q Wave

  His clinical history was characterized by a silent inferior-basal myocardial infarction detected by a control ECG that presented inferior Q waves, and he had not previously presented symptoms. [cardiothoracicsurgery.org]

• ST Elevation

  […] by, last update March 16, 2019 Left Ventricular Aneurysm Overview Persistent ST elevation following an acute myocardial infarction. [litfl.com]

  […] by, last update November 25, 2018 Left Ventricular Aneurysm Overview Persistent ST elevation following an acute myocardial infarction. [lifeinthefastlane.com]

  The only way to be sure that the ECG changes present are from an LV aneurysm (not ST elevation from an acute MI) is to have the patient’s history of a prior MI and cardiac imaging to document the presence of an aneurysm. [healio.com]

  Normal Right Bundle Branch Block (figure 2) This is normal RBBB, with rSR’, slight ST depression in V2 and V3, and no ST elevation anywhere. A non-pathologic RBBB has an rSR’ in V1-V3 and no ST elevation anywhere on the ECG. [hqmeded-ecg.blogspot.com]

• T Wave Inversion

  ECG Examples Example 1 Anterior Left Ventricular Aneurysm: Minimal ST elevation in V1-3 associated with deep Q waves and T-wave inversion. This is a LV aneurysm secondary to a prior anteroseptal STEMI. [litfl.com]

• Lymphocytic Infiltrate

  Histologically, CD3-positive T lymphocytic infiltration accompanied by pronounced macrophage infiltration was observed in the myocardium. Hemorrhagic necrosis was detected in the area of the ventricular aneurysm. [ncbi.nlm.nih.gov]

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