Left ventricular aneurysm natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Heart failure, ventricular arrhythmia, mural thrombosis and ventricular rupture are aneurysm complications they may develop despite proper treatment of underlying myocardial event. The overall prognosis is dependent to size of aneurysm, presence of akinesia and the extent of underlying cardiac event.
Natural History
If left untreated it may lead to heart failure and persistent anginal pain. For false aneurysms rupture and hemodynamic compromise are the outcomes if left untreated. Improvements in STEMI management, control of hypertension and avoidance of corticosteroids in STEMI have led to better prognosis and decreased mortality.[1]
Complications
Mural thrombi
It occurs in almost 50% of patients and can be detected by angiography or echocardiography.[1]
Heart failure
Paradoxical movement in the aneurysmal portion of the LV wall reduces efficiency of the ventricle contraction and some part of stroke volume steals by aneurysm. It may lead to LV dilation and increase in LV end-diastolic pressure and may be accompanied by chest pain.[2][3]
Arrhythmia
Approximately 15% have symptomatic ventricular arrhythmias that may be intractable and life-threatening.[4]
Ventricular rupture
A mature true LV aneurysm rarely ruptures but it is common for false aneurysms.[5]
Prognosis
Depending on the size of the aneurysm, extent of underlying cardiac event, presence of complication and prompt treatment the prognosis may vary but the overall prognosis improved by modern treatment and advanced management.
References
- ↑ 1.0 1.1 Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP (1968). "Clinical diagnosis and prognosis of ventricular aneurysm". Br Heart J. 30 (4): 497–513. PMC 487659. PMID 5659397.
- ↑ Nicolosi AC, Spotnitz HM (1988). "Quantitative analysis of regional systolic function with left ventricular aneurysm". Circulation. 78 (4): 856–62. PMID 3168193.
- ↑ Klein MD, Herman MV, Gorlin R (1967). "A hemodynamic study of left ventricular aneurysm". Circulation. 35 (4): 614–30. PMID 6024006.
- ↑ Waldo AL, Arciniegas JG, Klein H (1981). "Surgical treatment of life-threatening ventricular arrhythmias: the role of intraoperative mapping and consideration of the presently available surgical techniques". Prog Cardiovasc Dis. 23 (4): 247–64. PMID 7008078.
- ↑ Vlodaver Z, Coe JI, Edwards JE (1975). "True and false left ventricular aneurysms. Propensity for the altter to rupture". Circulation. 51 (3): 567–72. PMID 1132088.