Left ventricular pseudoaneurysm: Difference between revisions
| Line 9: | Line 9: | ||
==Clinical Features== | ==Clinical Features== | ||
* | *10% are asymptomatic <ref>Frances, C., Romero, A., Grady, D. (1998). Left ventricular pseudoaneurysm. Journal of the American College of Cardiology, 32(3); 557 - 61</ref> | ||
*History of [[MI]] | *History of [[MI]] or cardiac surgery | ||
*Angina | *Symptoms similar to congestive heart failure | ||
**[[Angina]] | |||
**[[Shortness of breath]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 16:53, 17 March 2019
Background
- Acute MI or surgical mishap causes ventricular free wall rupture [1]
- Contained by pericardial adhesions
- Morality rate high secondary to rupture of pseudoaneurysm
Causes
- Transmural MI (anterior or inferior most common)
- Surgical mishap
Clinical Features
- 10% are asymptomatic [2]
- History of MI or cardiac surgery
- Symptoms similar to congestive heart failure
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Evaluation
- LV angiography (TTE unreliable)
Management
- Surgical repair = 10% 5 yr mortality
- Medical therapy = 50% 5 yr mortality
Disposition
Complications
- Angina (increased O2 demand)
- Complete LV rupture