Ventricular Aneurysm

Ventricular aneurysm is marked by an out pouching (almost always of the left ventricle) that produces ventricular wall dysfunction in 10% to 20% of patients after myocardial infarction (MI). A ventricular aneurysm may develop within weeks after MI, usually following anterior P wave infarctions.

An untreated ventricular aneurysm can lead to arrhythmias, systemic embolization, or heart failure and may cause sudden death. Resection improves the prognosis in heart failure and in patients with refractory ventricular arrhythmias.

Causes

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

Accompanying ventricular aneurysm, abnormal muscle wall movement includes akinesia (lack of movement), dyskinesia (paradoxical movement), asynergia (decreased and inadequate movement), and asynchrony (uncoordinated movement).

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 in order 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.

Signs and symptoms

A ventricular aneurysm may cause arrhythmias (such as premature ventricular contractions and ventricular tachycardia), palpitations, signs of cardiac dysfunction (weakness on exertion, fatigue, angina) and, occasionally, a visible or palpable systolic precordial bulge.

This condition may also lead to left ventricular dysfunction, with chronic heart failure (dyspnea, fatigue, edema, crackles, gallop rhythm, neck vein distention); pulmonary edema; systemic embolization; and, with left-sided heart failure, pulsus alternans. Ventricular aneurysms enlarge but rarely rupture.

Treatment

Most cases of ventricular aneurysm are treated by close medical follow-up and limiting patient activity. Surgical removal of the aneurysm is an option when persistent left ventricular failure or arrhythmia occurs, and the aneurysm is large. Vasodilators , diuretics , and digoxin are used to treat heart failure . Anticoagulant drugs are used to prevent the formation of blood clots. Antiarrhythmic drugs are used to treat heart arrhythmias.

Prognosis

Ventricular aneurysm occurs more frequently than is commonly thought. Based on postmortem examination, ventricular aneurysm occurs in as many as 15% of myocardial infarction cases. Patients with a large ventricular aneurysm in the left ventricle have a reduced survival rate. Many patients have mild symptoms which are not life-threatening. The survival rate is dependent on the function of the left ventricle.

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