Edit concept Create issue ticket

Ventricular Aneurysm

A ventricular aneurysm develops either as a congenital or acquired malformation, but it is most frequently described as a complication of acute myocardial infarction. The clinical presentation can be asymptomatic, while chest pain, dyspnea, bradycardia, and a pericardial friction rub are some of the observed symptoms. A thorough clinical assessment with electrocardiography (ECG) can raise sufficient evidence to employ imaging studies (ventriculography, echocardiography, or magnetic resonance imaging). The latter is the cornerstone for determining the type (true vs pseudoaneurysm) and its size.


Presentation

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.

Sputum
  • […] infarction, depending on methods used for diagnosis and definition. 1,2 A 70 year old male patient was presented at Sultan Qaboos University Hospital in Salalah with a history of increasing shortness of breath and a cough producing a white coloured sputum[omjournal.org]
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]
  • 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]
  • This results in overall decrease in heart function and the development of congestive heart failure. 2. Left ventricular thrombus formation: When blood stagnates in any area of the body, there is a risk of platelet aggregation and thrombus formation.[healio.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]
Coronary Artery Disease
  • artery disease and myocardial infarction.[accesssurgery.mhmedical.com]
  • The patient was known to suffer from Coronary Artery Disease and experienced a myocardial infarction (MI) 10 years back where a coronary artery bypass surgery (CABG) was performed.[omjournal.org]
  • The extent of coronary artery disease and collateral blood supply in Groups I and II were directly related (p 0.012). Neither age, sex nor risk factors for coronary disease correlated with aneurysm formation.[content.onlinejacc.org]
  • Coronary angiography excluded coronary artery disease, and local or systemic inflammation was excluded based on laboratory data and MRI. MRI also excluded other cardiomyopathies.[jstage.jst.go.jp]
  • ABSTRACT Left ventricular (LV) aneurysms have as the main cause of formation, in up to 95% of the cases, the coronary artery disease: the ST myocardial infarction of the LV anterior wall, in association with total left anterior descending (LAD) coronary[tmj.ro]
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]
  • 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]
  • 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]
  • Ventricular tachycardia: The scar within the left ventricular aneurysm is a focus for ventricular arrhythmias which can lead to sudden cardiac death. 4.[healio.com]
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]
  • disease, unspecified I25 Chronic ischemic heart disease I25.1 Atherosclerotic heart disease of native coronary artery I25.10 …… without angina pectoris I25.11 Atherosclerotic heart disease of native coronary artery with angina pectoris I25.110 Atherosclerotic[icd10data.com]
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]

Workup

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.biomedcentral.com]
ST Elevation
  • […] by , last update November 25, 2018 Left Ventricular Aneurysm Overview Persistent ST elevation following an acute myocardial infarction.[lifeinthefastlane.com]
  • […] by , last update November 17, 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]
  • Note the ST elevation in the anterior leads.[en.wikipedia.org]
  • 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.[lifeinthefastlane.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]

Treatment

  • Surgery is the definitive treatment. However, it is not currently available in the country and patients cannot afford treatment abroad.[ncbi.nlm.nih.gov]
  • It is unclear as to whether polyphenol-containing topical treatments have similar effects.[ncbi.nlm.nih.gov]
  • Treatment [ edit ] 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]
  • Treatment is either surgical or conservative. Imaging is required for diagnosis and preoperative assessment. Multimodality imaging include echocardiography (ECHO), cardiac CTangiography and the robust multiparametric cardiac MR (CMR).[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • 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]
  • 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]
  • 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]
  • Abstract To determine the clinical and angiographic factors responsible for left ventricular aneurysm formation and the prognosis of patients with aneurysm, 79 patients with a first acute transmural anterior myocardial infarction and angiographically[ncbi.nlm.nih.gov]

Etiology

  • Although it occurs as a consequence of a variety of conditions, congenital ventricular septal defect (VSD) as an etiology for the RVA has not been previously reported.[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]
  • 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]
  • 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]
  • The etiology of cardiomyopathy in chronic CD is not completely understood.[heartviews.org]

Epidemiology

  • Vai 2008 Modificazioni morfo-strutturali placentari nel ritardo di crescita asimmetrico idiopatico [Morphological and structural placental changes in intrauterine growth-restricted fetuses] Articolo su rivista Vai 2008 Cervico-Facial Actinomycosis: Epidemiological[unipa.it]
Sex distribution
Age distribution

Pathophysiology

  • […] 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]
  • Ultrasound Obstet Gynecol 25:401â “404 Ohlow MA (2006) Congenital left ventricular aneurysms and diverticula: Definition, pathophysiology, clinical relevance and treatment.[gerboni.net]
  • 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]

Prevention

  • 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]
  • Also ACE Inhibitors seem to prevent Left Ventricular remodeling and aneurysm formation.[en.wikipedia.org]
  • […] 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]
  • Abstract The incidence and prevention of systemic embolism in patients with chronic left ventricular aneurysm have been controversial.[onlinejacc.org]
  • The surgeon is able to get a clear view of your heart’s health and can thus take appropriate treatment and preventive measures.[bumc.bu.edu]

References

Article

  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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 02:47