Ventricular Aneurysm

Definition

Ventricular aneurysm is a complication of a heart attack (myocardial infarction). It is a ballooning of a section of a blood vessel in the heart that first appears several days or weeks after an acute myocardial infarction.

Description

A myocardial infarction occurs when a section of the heart wall is deprived of blood and dies (undergoes necrosis, or tissue death, and scarring). The heart wall is mainly muscle. It has two ventricles, the right and left ventricles, which pump blood to and from the lungs, and to the body. When part of the heart muscle dies, pumping power from that part of the wall is lost. After a myocardial infarction, the part of the heart wall that did not die must continue pumping blood and compensate for the dead muscle.

Ventricular aneurysm is one of the complications that follow a myocardial infarction.

An aneurysm is the outward swelling, or ballooning, of a blood vessel at a weak spot in the wall of the blood vessel. In the case of ventricular aneurysm, the aneurysm occurs in the wall of the heart at the spot where the myocardial infarction occurred. A scar usually forms in the area of the dead muscle tissue, and may eventually calcify. Ventricular aneurysms generally do not rupture. The left ventricle is involved in most cases of ventricular aneurysm.

Causes and symptoms

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. Ventricular aneurysm is seldom seen immediately after a myocardial infarction. It takes several days or weeks to several months to develop. Frequently, recurrent ventricular irregular heartbeats (arrhythmias ) and low cardiac output result from the presence of a ventricular aneurysm. Blood clots (thrombi) may form on the inside wall of the aneurysm and produce systemic blood clots that get stuck in a blood vessel (embolisms), which could lead to stroke or an ischemic leg (a usually painful condition in which lack of blood circulation leads to reduced function).

Diagnosis

A number of signs may indicate ventricular aneurysm, including an abnormal precordial impulse in the heartbeat, persistent elevation of the S-T segment of an electrocardiogram, and a characteristic bulge seen on the heart when x rayed. The bulge is typically seen when the heart contracts, driving blood to the aorta, in the systolic phase of the heartbeat. Echolocation (echocardiography or ultrasound) can confirm the presence of an aneurysm. Cardiac catheterization may be performed to determine the extent of the aneurysm and the status of the coronary arteries. Stethoscopic examination reveals abnormal heart sounds, especially those associated with a backflow of blood from the left ventricle to the left atrium in systole or contraction beat (mitral regurgitation). This heart murmur is caused by the heart muscles no longer being able to properly operate the mitral valve.

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.

Resources

BOOKS

Alexander, R. W., R. C. Schlant, and V. Fuster, editors. The Heart. 9th ed. New York: McGraw-Hill, 1998.

KEY TERMS

Arrhythmia— A disturbance in the beating pattern of the heart.

Myocardial infarction— Commonly known as a heart attack, a myocardial infarction occurs when a part of the heart muscle is deprived of blood and dies.