Left ventricular aneurysm
Introduction
LV Aneurysm = 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
Diagnosis
- Can be asymptomatic
- Hx of MI
- Angina, SOB/DOE, CHF sx
- Mitral regurg murmur, S3/S4
- EKG: persistent characteristic ST elevation after MI
- CXR: prominent left heart border, calcified aneurysm
- TTE, LV angiography, cardiac MRI
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)
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