Left ventricular aneurysm

(Redirected from Left Ventricular Aneurysm)

Background

Left ventricular aneurysm: thinned wall in upper right of picture (short axis view)
eft ventricular aneurysm: thinned wall bottom right of picture (long axis view)
  • Thin or fibrotic ventricular wall
    • Muscle may be absent or necrotic
    • Akinetic or dyskinetic wall (paradoxical ballooning)

Causes

  • Majority
    • Healed transmural MI (anterior or inferior most common)
  • Rare

Clinical Features


Complications

Differential Diagnosis

ST Elevation

Evaluation

Workup

ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.
  • ECG
    • Persistent characteristic ST elevation after MI
    • Non-specific ST segment changes
    • Q or QS waves
    • T waves small relative to QRS
    • No reciprocal changes
  • CXR
    • Prominent left heart border
    • Calcified aneurysm
    • May have mass-like appearance
  • TTE
  • LV angiography
  • Cardiac MRI

Diagnosis

Differentiate left ventricular aneurysm from STEMI and other causes of ST-elevation

  • Strongly suspect STEMI if:
    • Symptomatic
    • No q waves present (LV aneurysm typically produces significant q waves)
    • Evolving changes on serial ECG
    • Reciprocal changes
  • Consider two rules to differentiate[1]
    • Rule 1
      • If (Sum of T-wave amplitudes in V1-V4) divided by (Sum of QRS amplitudes in V1-V4) > 0.22
      • Suggestive of STEMI, with ~87% accuracy
    • Rule 2
      • If any lead in V1-V4 has T-wave amplitude to QRS amplitude ratio > 0.35
      • Suggestive of STEMI, with ~89% accuracy

STEMI Stages of Development

Stage Duration Timing Finding ECG
1

STEMI-b.jpg

30min - hours Hyperacute T waves
  • >6mm limb leads
  • >10mm precordial leads
Normalizes in days, weeks, or months
2

STEMI-c.jpg

Minutes - hours ST segment elevation
  • 0.1mV in two or more contiguous leads
ST segment resolution occurs over 72hrs; completely resolves within 2-3wks
3

STEMI-d2.jpg

Within 1hr; completed within 8-12hr Q waves Persist indefinitely in 70% of cases

Management

  • Be sure to rule out acute or subacute coronary syndrome

Medical Therapy (first line)

Surgical Therapy

  • Aneurysmectomy and CABG (and possible valve repair) if ventricular arrhythmias and/or HF refractory to medical therapy

Disposition

  • Cardiothoracic surgery consultation

See Also

References

  1. Klein LR, Shroff GR, Beeman W, and Smith SW. Electrocardiographic criteria to differentiate acute anterior ST-elevation myocardial infarction from left ventricular aneurysm. Am J Emerg Med. 2015 Jun;33(6):786-90.

Authors:

Ross Donaldson