Left ventricular aneurysm

From WikEM
(Redirected from Left Ventricular Aneurysm)
Jump to: navigation, search


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


  • 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 regurgitation murmur, S3/S4

Differential Diagnosis


  • CXR: prominent left heart border, calcified aneurysm
  • TTE, LV angiography, cardiac MRI
  • ECG: persistent characteristic ST elevation after MI
  • 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


  • Be sure to rule out acute or subacute acute coronary syndrome

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


  • 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

  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.