Left ventricular aneurysm

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Overview
Left ventricular aneurysm  (LVA) is a sequela to myocardial infarction which occurrs in 10% to 30% of patients surviving an acute myocardial infarction.

Classification of Left Ventricular Aneurysms
Left ventricular aneurysms are classified as true and false aneurysms. While both true aneurysms and false (pseudo) ventricular aneurysms are the sequelae of myocardial infarction, their etiology, pathologic findings, diagnostic findings, and treatment are different.

True Left Ventricular Aneurysm
A true left ventricular aneurysm has an aneurysmal sac which contains the endocardium, epicardium, and thinned fibrous tissue (scar) that is a remnant of the left ventricular muscle. A true left ventricular aneurysm, particularly if small, may cause few or any symptoms and is compatible with prolonged survival. Rupture of a true aneurysm is relatively uncommon. Surgical resection is therefore only necessary when refractory angina pectoris, congestive heart failure, systemic embolization, or refractory arrhythmias are present.

False Left Ventricular Aneurysm or Pseudoaneurysm
Unlike a true aneurysm, which contains some myocardial elements in its wall, the walls of a false aneurysm are composed of organized hematoma and pericardium and lack any element of the original myocardial wall. A false aneurysmal sac represents a pericardium that contains a ruptured left ventricle. In contrast to true aneurysms, false aneurysms have a greater tendency to rupture and require surgical repair.

Electrocardiogram
True aneurysms distort the shape of the left ventricle during both diastole and systole, and the motion of the aneurysmal segment is paradoxical. This can be associated with ST changes including ST elevation, particularly at high heart rates as might be encountered during exercise.

Radiographic Findings
(Radiological Images Courtesy of RadsWiki)

Chest X Ray
The presence of a discrete bulge in the heart anteriorly is suggestive of a true aneurysm.

Chest CT Scan

 * True aneurysms will often have a wide neck and are often apical in location.
 * False aneurysms will often have a narrow neck and are often posterior diaphragmatic in loccation.

Pathology Findings
==ACC/AHA Guidelines (DO NOT EDIT) ==

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Class IIa
1. It is reasonable that patients with STEMI who develop a ventricular aneurysm associated with intractable ventricular tachyarrhythmias and/or pump failure unresponsive to medical and catheterbased therapy be considered for LV aneurysmectomy and CABG surgery. (Level of Evidence: B) }}