Left ventricular aneurysm: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "EKG" to "ECG") |
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==Clinical Features== | ==Clinical Features== | ||
*Can be asymptomatic | *Can be asymptomatic | ||
* | *History of MI | ||
*Angina, SOB/DOE, CHF sx | *Angina, SOB/DOE, CHF sx | ||
*Mitral regurg murmur, S3/S4 | *Mitral regurg murmur, S3/S4 | ||
Revision as of 23:39, 14 July 2016
Background
- thin/fibrotic wall with no/necrotic muscle that is akinetic or dyskinetic (paradoxical ballooning)
Causes
Clinical Features
- Can be asymptomatic
- History of MI
- Angina, SOB/DOE, CHF sx
- Mitral regurg murmur, S3/S4
Differential Diagnosis
Diagnosis
- ECG: persistent characteristic ST elevation after MI
- CXR: prominent left heart border, calcified aneurysm
- TTE, LV angiography, cardiac MRI
Management
Medical Therapy (first line)
- Afterload reduction (ACEI)
- Antianginal (Nitro)
- Anticoagulation (if LV thrombus)
Surgical Therapy
- Aneurysmectomy and CABG (and possible valve repair) if ventricular arrhythmias and/or HF refractory to medical therapy
Complications
- Heart failure (LV aneurysm steals CO)
- Angina (increased O2 demand)
- Ventricular arrhythmias (LV stretch/scarring)
- LV thrombus (50% of time), arterial embolism (stroke)
- LV rupture (rarely occurs in mature LVA because of dense fibrosis)