Left ventricular aneurysm 

Introduction

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.

Clinical significance

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.

ECG manifestation

  • Persistent ST elevation (most commonly in precordial leads) seen post an acute MI 
  • Usually associated with well-formed Q- or QS waves (presence of QS waves on initial ECG is a predictor of early LVA).
  • T waves have a relatively small amplitude in comparison to the QRS complex (unlike the hyperacute T-waves of acute STEMI).

 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

 Treatment

 Ventricular aneurysm treatment depends on the aneurysm’s size, location and your overall health.

  • anticoagulation therapy to prevent or treat blood clot
  • ventricular reconstructive surgery if causing heart failure

 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  

 

References

  1. ZHANG, Zenghui a Jun GUO. Predictive risk factors of early onset left ventricular aneurysm formation in patients with acute ST-elevation myocardial infarction. Heart [online]. 2020, 49(1), 80-85 [cit. 2021-02-03]. ISSN 01479563. 
  2. OLA, Olatunde, Carissa DUMANCAS, Tuoyo Omasan MENE-AFEJUKU, Adedoyin AKINLONU, Mohammed AL-JUBOORI, Ferdinand VISCO, Savi MUSHIYEV a Gerald PEKLER. Left Ventricular Aneurysm May Not Manifest as Persistent ST Elevation on Electrocardiogram. American Journal of Case Reports [online]. 2017, 18, 410-413 [cit. 2021-02-03]. ISSN 15076164. 
  3. Oz M Shapira, Bernard J Gersh, Gordon M Saperia. Left ventricular aneurysm and pseudoaneurysm following acute myocardial infarction. https://www.uptodate.com
  4. https://litfl.com/left-ventricular-aneursym-ecg-library/
  5. https://www.medscape.com/answers/155919-15221/what-is-a-left-ventricular-aneurysm-and-what-are-the-risk-factors-for-these-aneurysms-after-acute-myocardial-infarction-mi-heart-attack