Left ventricular aneurysm

Revision as of 11:51, 9 September 2016 by Rossdonaldson1 (talk | contribs) (Text replacement - "*CXR" to "*CXR")

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
  • History of MI
  • Angina, shortness of breath/DOE, CHF sx
  • Mitral regurg murmur, S3/S4

Differential Diagnosis

Evaluation

  • ECG: 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)

See Also

Myocardial Infarction Complications

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