A left ventricular aneurysm can form after a transmural myocardial infarction and involves dilation of the left ventricular wall in an abnormal fashion. Most commonly, the apex of the heart is involved however, the inferior wall can form an aneurysm as well.
The four main concerns in patients with left ventricular aneurysm are:
1. Heart failure: The portion of the heart that contains the aneurysm is not contractile and is frequently “dyskinetic”. This results in overall decrease in heart function and the development of congestive heart failure.
2. Left ventricular thrombus formation: When blood stagnates in any area of the body, there is a risk of platelet aggregation and thrombus formation. The aneurysmal portion of the LV is no different. Embolization of left ventricular thrombi can lead to embolic stroke or other systemic embolisms.
3. Ventricular tachycardia: The scar within the left ventricular aneurysm is a focus for ventricular arrhythmias which can lead to sudden cardiac death.
4. Angina pectoris: The aneurysmal tissue can still cause symptoms of angina, even if revascularized.
A LV aneurysm can be diagnosed on ECG when there is persistent ST segment elevation occurring 6 weeks after a known transmural MI (usually anterior). Without knowing the persons past medical history, the ECG changes of an aneurysm may mimic an acute ST segment elevation MI. With an anterior or apical aneurysm, the persistent ST elevation is in lead V1 and V2. In an inferior aneurysm it would be in lead II, III and aVF. The only way to be sure of an LV aneurysm diagnosis on an ECG (not from an acute MI) is to have the patient’s history of a prior heart attack and cardiac imaging to document the presence of an aneurysm. The shape of the ST elevation is also relatively unique and has been described as “coving”. The ECG below is an example of findings from LV aneurysm:
Left ventricular aneurysm.
There is a surgical procedure during which the surgeon resects the aneurysm and uses a Dacron patch. This is called the “Dor procedure” or the EVCPP (endoventricular circular patch plasty). This procedure is indicated when medical therapy fails to control or acceptably improve the above mentioned complications/symptoms from the left ventricular aneurysm.
Think Again...ECG Case #1 - Crazy Left Ventricular Aneurysm Case
By Steven Lome