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]

  While he had recovered well from surgery he suffered from progressive congestive heart failure (NYHA III) during the past year. He was admitted to our institution for evaluation for heart transplantation. [thieme-connect.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]

• Tachycardia

  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]

  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]

  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]

  Sinus tachycardia may be due to pain, anxiety, or drugs. Atrial fibrillation and other supraventricular tachycardias may also occur. [patient.info]

• Heart Disease

  ICD-10-CM Codes › I00-I99 Diseases of the circulatory system › I20-I25 Ischemic heart diseases › I25- Chronic ischemic heart disease › Aneurysm of heart 2016 2017 2018 2019 Billable/Specific Code I25.3 is a billable/specific ICD-10-CM code that can be [icd10data.com]

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

  […] manifesting as sinus node disease, complete heart block, or bundle branch block. [heartviews.org]

• 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]

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].

• 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. [lifeinthefastlane.com]

  A left ventricular aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural myocardial infarction (usually an anterior MI). [healio.com]

  Classic ECG findings are persistent ST elevation and deep Q waves in the same leads. [radiopaedia.org]

• T Wave Inversion

  T-wave/QRS ratio > 0.36 in any precordial lead favours anterior STEMI. ECG Examples Example 1 Anterior Left Ventricular Aneurysm: Minimal ST elevation in V1-3 associated with deep Q waves and T-wave inversion. [lifeinthefastlane.com]

Surgery is the definitive treatment. However, it is not currently available in the country and patients cannot afford treatment abroad. [ncbi.nlm.nih.gov]

Some people live with this type of aneurysm for many years without any specific treatment. Treatment is limited to surgery (ventricular reduction) for this defect of the heart. [en.wikipedia.org]

This patient's condition improved after treatment with diuresis and inotropic therapy, and he was discharged home. [nejm.org]

The etiology is unknown, and there is a variable prognosis in the current literature. Approximately 20 cases detected by prenatal ultrasonography have been reported, with 4 of these cases indicating the presence of pericardial fluid. [ucdavis.pure.elsevier.com]

In our case, LVA/LV ratio was >1 throughout the pregnancy that suggested poor prognosis ( Figure 2a ). With the relative enlargement of aneurysm, we expected poor prognosis of this fetus. [nature.com]

While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. [ncbi.nlm.nih.gov]

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 [symptoma.com]

Treatment and prognosis The rate of mortality in patients with left ventricular aneurysms is up to 6x higher than in patients without aneurysms. [radiopaedia.org]

/etiology; ventricular function, left/drug effects/physiology [ncbi.nlm.nih.gov]

The etiology is unknown, and there is a variable prognosis in the current literature. Approximately 20 cases detected by prenatal ultrasonography have been reported, with 4 of these cases indicating the presence of pericardial fluid. [ucdavis.pure.elsevier.com]

DISCUSSION Congenital VA is a rare clinical entity (0.4% of 750 cardiac necropsies) 4 that is diagnosed once other more common etiologies have been ruled out. [revespcardiol.org]

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. [symptoma.com]

[…] of authors favor defining left ventricular aneurysm more loosely as any large area of left ventricular akinesia or dyskinesia that reduces left ventricular ejection fraction. 3–5 This broader definition has been justified by data suggesting that the pathophysiology [accesssurgery.mhmedical.com]

The underlying pathophysiological processes are little understood; however, it is hypothesized that they result from a localized weakening of the ventricular wall due to an interruption in the development during embryogenesis, infection, or ischemia 2,3 [scielo.br]

Congenital left ventricular aneurysms and diverticula: definition, pathophysiology, clinical relevance and treatment. Cardiology 2006; 106 : 63–72. 3. Weichert J, Chiriac A, Axt-Fliedner R. [nature.com]

Left ventricular aneurysms: pathophysiologic observations and standard resection. Sem Thorac Cardiovasc Surg 1997;9:113-22. 9. Grieco JG, Montoya A, Sullivan HJ, et al. Ventricular aneurysm due to blunt chest injury. [tmj.ro]

Optimal physiologic management may differ among all the existing pathophysiologies, making the anesthetic management challenging. Intraoperative transesophageal echocardiography (TEE) is essential for several reasons. [clinicalpainadvisor.com]

How can a ventricular aneurysm be prevented? Some aneurysms may be prevented if a heart attack is treated very soon after it starts. Developed by RelayHealth. Published by RelayHealth. [summitmedicalgroup.com]

[…] these complications, 7,8 although some groups defend a conservative attitude in asymptomatic patients and employ measures aimed at preventing endocarditis and embolism via oral antiplatelet or anticoagulation agents. 3 In our case, despite involving [revespcardiol.org]

The patient also received an implantable cardioverter-defibrillator for primary prevention. [doi.org]

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7. Gerlis LM, Partridge JB, Fiddler GI, Williams G, Scott O. Two chambered left ventricle: three new varieties. Br Heart J. 1981;46:278–284.
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