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

  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]

  The reduced left ventricular ejection fraction may lead to congestive heart failure and predispose to ventricular arrhythmias. [brown.edu]

  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. [doi.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]

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

  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

  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]

  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]

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

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

• Vascular Disease

  The patient was a smoker, affected by chronic obstructive pulmonary disease (COPD), hypertension, and peripheral vascular disease, presented in sinus rhythm. Medical therapy was based beta blockers, ASA, and a diuretic with some relief of symptoms. [doi.org]

  […] treated with ablation therapy or implanted cardiac defibrillator, mechanical ventricular assistance (intra-aortic balloon pump or LVAD), mitral regurgitation, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease (COPD) [clinicalpainadvisor.com]

  基礎疾患、原疾患 unstable angina pectoris (UAP) 不安定狭心症 v vagotomy迷走神経切除 vagotonia迷走神経緊張 valve area弁口面積 valve replacement弁置換[術] valvular (heart) disease ［心臓］弁膜症 valvuloplasty弁形成［術］ vanishing tumor一過性腫瘤状陰影 variation変動 varicose veins 拡張蛇行静脈 vasa vasorum栄養血管 vascular [tokyo-med.ac.jp]

• Cyanosis

  動脈形成術 coronary artery冠［状］動脈 coronary artery bypass grafting (CABG) 冠［状］動脈バイパス［手］術 coronary artery disease (CAD)冠［状］動脈疾患 coronary circulation 冠循環 coronary risk factor冠危険因子 corrected transposition of great arteries修正大血管転位［症］ countershock電気ショック cusp［弁］尖 cyanosis [tokyo-med.ac.jp]

• Sweating

  Hi bigmak1 my baby have this problem.but he hasn't any symptoms.but sometimes he sweats. I want to know about prognosis,my baby is 4 months.how is your baby now? hope heis doing great. god bless you and your baby Hi! My daughter has this as well. [community.babycenter.com]

• Diplopia

  At 34 years old she was examined due to symptoms of diplopia with suspected transitory ischemic attack (TIA) without any other cardiovascular symptoms. Electrocardiogram (ECG) presented an image of old inferior and anteroseptal necrosis (Figure 1). [revespcardiol.org]

• Stroke

  Post Operative ComplicationsLow cardiac output - 22%–39%Ventricular arrhythmias - 9%–19%Respiratory failure - 4%–11%Bleeding - 4%–7%Dialysis-dependent renal failure - 4%Stroke - 3%–4% 48. [slideshare.net]

  Such an aneurysm represents non-contractile tissue that reduces stroke volume and strains the remaining myocardium. The stasis of blood in the aneurysm predisposes to mural thrombosis. [library.med.utah.edu]

  Stroke 1993;24:1865–1873. Bianchi F, Brignole M: Rara associazione di aneurisma del setto interatriale e tachicardia ventricolare. G Ital Cardiol 1990;20:734–737. [karger.com]

  Alternatively, if a clot blocks a vessel going to the brain, it can cause a stroke. In certain cases, ventricular aneurysms cause ventricular failure or arrythmia. At this stage, treatment is necessary. [en.wikipedia.org]

  Prognosis Related to degree of clot burden, dysrhythmias, and/or affect on stroke volume. [vcuthoracicimaging.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. [doi.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]

  Here is his ED ECG: There is ST elevation in V1-V3. The Computer Read: "Anterior ST Elevation ***Acute MI*** What do you think? There is not just ST elevation, but there are QS-waves in V1-V3. [hqmeded-ecg.blogspot.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]

• 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. [litfl.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]

[…] and minimally invasive treatments. [bumc.bu.edu]

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]

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]

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]

Treatment and prognosis Approximately 25% (range 19-32%) of patients are at risk of fatal ventricular rupture, and about 30-45% of left ventricular pseudoaneurysms will eventually rupture. [radiopaedia.org]

It is suggested that the hemodynamic significance of ventricular aneurysms is not ordinarily great, in view of the unaffected statistical prognosis in its presence. [ahajournals.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]

Abstract In a review of 160 cases of hypertrophic cardiomyopathy which underwent hemodynamic studies, 3 cases of apical aneurysm of the left ventricle of unidentifiable etiology were found. [jstage.jst.go.jp]

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]

[…] 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]

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

Medicines may be used temporarily to help with symptoms, but they don't cure the VSD or prevent permanent damage to the lung arteries. [heart.org]

1. Kumbasar B, Wu KC, Kamel IR, Lima JA, Bluemke DA. Left ventricular true aneurysm: diagnosis of myocardial viability shown on MR imaging. AJR Am J Roentgenol. 2002;179(2):472-474.
2. Bisoyi S, Dash AK, Nayak D, Sahoo S, Mohapatra R. Left ventricular pseudoaneurysm versus aneurysm a diagnosis dilemma. Ann Card Anaesth. 2016;19(1):169-172.
3. Alhasnawi M. Calcified Ventricular Aneurysm. Oman Med J. 2009;24(4):303-305.
4. Giacobbe L, Williams P, Ramin K, Sivanandam S. Fetal Diagnosis of Left Ventricular Aneurysm: A Case Report. AJP Rep. 2011;1(2):91-94.
5. Del Río M, Martínez J M, Bennasar M., et al. Prenatal diagnosis of a right ventricular diverticulum complicated by pericardial effusion in the first trimester. Ultrasound Obstet Gynecol. 2005;25:409–411.
6. Ercan A, Senkaya I, Semizel E, Cil E. Left Ventricular Aneurysm in a 4-Year-Old Boy.Tex Heart Inst J. 2005;32(4):614-615.
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.
8. Balakumar K. Prenatal diagnosis of left ventricular aneurysm. Indian J Radiol Imaging. 2009;19(1):84-86.