Left ventricular aneurysm: Difference between revisions
m (Rossdonaldson1 moved page Left Ventricular Aneurysm to Left ventricular aneurysm) |
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== | ==Background== | ||
*thin/fibrotic wall with no/necrotic muscle that is akinetic or dyskinetic (paradoxical ballooning) | |||
==Causes== | ===Causes=== | ||
*Majority: healed transmural MI (anterior most common) | *Majority: healed transmural [[MI]] (anterior most common) | ||
*Rare: HOCM, Chagas | *Rare: [[HOCM]], [[Chagas]] | ||
== | ==Clinical Features== | ||
*Can be asymptomatic | *Can be asymptomatic | ||
*Hx of MI | *Hx of MI | ||
*Angina, SOB/DOE, CHF sx | *Angina, SOB/DOE, CHF sx | ||
*Mitral regurg murmur, S3/S4 | *Mitral regurg murmur, S3/S4 | ||
==Differential Diagnosis== | |||
*[[Left Ventricular Pseudoaneurysm]] | |||
==Diagnosis== | |||
*EKG: persistent characteristic ST elevation after MI | *EKG: persistent characteristic ST elevation after MI | ||
*CXR: prominent left heart border, calcified aneurysm | *CXR: prominent left heart border, calcified aneurysm | ||
*TTE, LV angiography, cardiac MRI | *TTE, LV angiography, cardiac MRI | ||
==Management== | |||
===Medical Therapy (first line)=== | |||
*Afterload reduction (ACEI) | |||
*Antianginal (Nitro) | |||
*Anticoagulation (if LV thrombus) | |||
===Surgical Therapy=== | |||
*Aneurysmectomy and CABG (and possible valve repair) if ventricular arrhythmias and/or HF refractory to medical therapy | |||
==Complications== | ==Complications== | ||
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*LV thrombus (50% of time), arterial embolism (stroke) | *LV thrombus (50% of time), arterial embolism (stroke) | ||
*LV rupture (rarely occurs in mature LVA because of dense fibrosis) | *LV rupture (rarely occurs in mature LVA because of dense fibrosis) | ||
==See Also== | ==See Also== | ||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 11:49, 29 June 2015
Background
- thin/fibrotic wall with no/necrotic muscle that is akinetic or dyskinetic (paradoxical ballooning)
Causes
Clinical Features
- Can be asymptomatic
- Hx of MI
- Angina, SOB/DOE, CHF sx
- Mitral regurg murmur, S3/S4
Differential Diagnosis
Diagnosis
- EKG: persistent characteristic ST elevation after MI
- CXR: prominent left heart border, calcified aneurysm
- TTE, LV angiography, cardiac MRI
Management
Medical Therapy (first line)
- Afterload reduction (ACEI)
- Antianginal (Nitro)
- Anticoagulation (if LV thrombus)
Surgical Therapy
- Aneurysmectomy and CABG (and possible valve repair) if ventricular arrhythmias and/or HF refractory to medical therapy
Complications
- Heart failure (LV aneurysm steals CO)
- Angina (increased O2 demand)
- Ventricular arrhythmias (LV stretch/scarring)
- LV thrombus (50% of time), arterial embolism (stroke)
- LV rupture (rarely occurs in mature LVA because of dense fibrosis)