Left ventricular aneurysm

Background

• thin/fibrotic wall with no/necrotic muscle that is akinetic or dyskinetic (paradoxical ballooning)

Causes

• Majority: healed transmural MI (anterior most common)
• Rare: HOCM, Chagas

Clinical Features

• Can be asymptomatic
• Hx of MI
• Angina, SOB/DOE, CHF sx
• Mitral regurg murmur, S3/S4

Differential Diagnosis

• Left Ventricular Pseudoaneurysm

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)