Ventricular aneurysm

• Myocardial infarction (occurs in 8–15% of patients; 2 weeks to months after MI)

• Risk factors [19]

  • Complete occlusion of the left anterior descending coronary artery

  • Female sex

∼ 85% in the anterior or apical walls, 10–15% in the inferior-basal walls of the left ventricle

• Enlarged heart on percussion

• Diffuse and displaced apical pulse to left midclavicular line

• 3rd and 4thheart sounds

• Systolic murmur (mitral regurgitation)

• ECG: persistent ST elevation

• Echocardiography (or CT or MRI ): dyskinetic wall motion and diastolic deformity

• Arrhythmias

• Ventricular rupture → cardiac tamponade

• Thrombus formation → thromboembolism (stroke, mesenteric ischemia, renal infarction)

• Heart failure

• Small and asymptomatic: conservative treatment with regular follow-up

• If large, symptomatic, or there is evidence of a thrombus

  • ACE inhibitors

  • Anticoagulation

• If not responsive to medical therapy: surgical resection of the aneurysm