Ventricular Aneurysm
Ventricular aneurysm is a potentially life-threatening condition that involves an outpouching—almost always of the left ventricle—that produces ventricular wall dysfunction in about 20% of patients after myocardial infarction (MI). Ventricular aneurysm may develop within days to weeks after MI or may be delayed for years. Resection improves the prognosis in patients with ventricular failure or ventricular arrhythmias.
Causes
MI causes ventricular aneurysm. When MI destroys a large muscular section of the left ventricle, necrosis reduces the ventricular wall to a thin sheath of fibrous tissue. Under intracardiac pressure, this thin layer stretches and forms a separate noncontractile sac (aneurysm). Abnormal muscle wall movement accompanies ventricular aneurysm. (See Understanding ventricular aneurysm, page 960.)
During systolic ejection, the abnormal muscle wall movements associated with
the aneurysm cause the remaining normally functioning myocardial fibers to increase the force of contraction to maintain stroke volume and cardiac output. At the same time, a portion of the stroke volume is lost to passive distention of the noncontractile sac.
the aneurysm cause the remaining normally functioning myocardial fibers to increase the force of contraction to maintain stroke volume and cardiac output. At the same time, a portion of the stroke volume is lost to passive distention of the noncontractile sac.
Complications
Ventricular aneurysms enlarge but seldom rupture. However, an untreated ventricular aneurysm can lead to ventricular arrhythmias, cerebral embolization, or heart failure and is potentially fatal.
Assessment
The patient may have a history of a previous MI. However, sometimes MI is silent, and the patient may be unaware of having had one. He may complain of palpitations and anginal pain.
If the patient has developed heart failure as a result of the aneurysm, he may complain of dyspnea, fatigue, and edema.
Inspection of the chest may reveal a visible or palpable systolic precordial bulge. Distended neck veins may appear if heart failure is present.
Palpation of peripheral pulses may reveal an irregular rhythm caused by arrhythmias (such as premature ventricular contractions or ventricular tachycardia). A pulsus alternans may be felt. Palpation of the chest usually detects a double, diffuse, or displaced apical impulse.
Auscultation of the heart may detect an irregular rhythm and a gallop rhythm. Crackles and rhonchi may be present in the lung if heart failure is present.
Diagnostic tests
The following tests may determine the presence of a ventricular aneurysm.
Two-dimensional echocardiography demonstrates abnormal motion in the left ventricular wall.
Left ventriculography reveals left-ventricular enlargement, with an area of akinesia or dyskinesia (during cineangiography), and diminished cardiac function.
Electrocardiography may show persistent ST-T wave elevations at rest. STsegment
elevation over the aneurysm creates an elevated rounded appearance.
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