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Ventricular Aneurysm
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Ventricular Aneurysm

What is Ventricular Aneurysm?

Ventricular aneurysm is a potentially life-threatening condition that involves an out pouching - almost always of the left ventricle - that produces ventricular wall dysfunction in about 20% of patients after myocardial infarction (MI). It 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 of Ventricular Aneurysm

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.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.

Signs & Symptoms of Ventricular Aneurysm

The principle symptom of a ventricular aneurysm is cardiac insufficiency, a condition in which not enough blood is being pumped to the body. Ventricular aneurysm is usually found after a large infarction in the muscle wall of a ventricle

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 cineangiocardiography) and diminished cardiacu function.
  • Electrocardiography may show persistent ST-segment and T-wave elevations at rest. ST-segment elevation over the aneurysm creates an elevated rounded appearance. Chest X-rays may disclose an abnormal bulge distorting the heart's contour if the aneurysm is large; X-rays may be normal if the aneurysm is small.
  • Noninvasive nuclear cardiology scan may indicate the site of infarction and suggest the area of aneurysm.

Treatment

Depending on the size of the aneurysm and the presence of complications, treatment may require only routine medical examination to follow the patient's condition, or aggressive measures for intractable ventricular arrhythmias, heart failure, and emboli.

Emergency treatment of ventricular arrhythmia includes I.V. antiarrhythmics, cardioversion, and defibrillation. Preventive treatment continues with oral antiarrhythmics, such as procainamide, quinidine, or disopyramide.

Emergency treatment for heart failure with pulmonary edema includes oxygen, digoxin LV., furose­mide I.V., potassium replacement, morphine sulfate I.V. and, when necessary, nitroprusside I.V. and endotracheal (ET) intubation. Maintenance therapy may include oral nitrates, prazosin, and hydralazine. Systemic embolization requires anticoagulation therapy or embolectomy. Refractory ventricular tachycardia, heart failure, recurrent arterial embolization. and persistent angina with coronary artery occlusion may require surgery. The most effective surgery is aneurysmectomy with myocardial revascularization.

 

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