Left ventricular aneurysm (LVA) is defined as a localized area of myocardium with abnormal outward bulging and deformation during systole and diastole. The wall is well delineated, thin, scarred, or fibrotic, devoid of muscle or containing necrotic muscle, as a result of a healed transmural myocardial infarction (MI). The involved wall segment is either akinetic or dyskinetic during systole.
Vast majority of LVA is a result of MI (mainly anterior MI). Other causes include hypertrophic cardiomyopathy, Chagas disease, cardiac infection and congenital malformations.
Aneurysms of the apex and anterior wall are more than four times as common as those of the inferior or inferoposterior walls.
LVA leads to blood pooling and secondary thrombus formation, putting the patient at greater risk for systemic embolization and cardioembolic stroke.
As scar tissue is arrhythmogenic, LVA can lead to ventricular arrhythmias and sudden death.
Congestive heart failure is a further complication of LVA.
It is very important to distinguish between LVA and acute STEMI:
- absence of reciprocal ST depression
- well-formed Q waved
- no dynamic ST segment changes
Ventricular aneurysm treatment depends on the aneurysm’s size, location and your overall health.
ECG 1 Aneurysm of anterior and apical parts of left ventricle with present thrombus
ECG 2 Aneurysm of anterior and apical wall of left ventricle