Left ventricular aneurysm natural history, complications and prognosis: Difference between revisions
No edit summary |
No edit summary |
||
Line 3: | Line 3: | ||
{{CMG}};{{AE}}{{MehdiP}} | {{CMG}};{{AE}}{{MehdiP}} | ||
==Overview== | ==Overview== | ||
[[Heart failure]], [[Ventricular arrhythmias|ventricular arrhythmia]], mural [[thrombosis]] and ventricular rupture are aneurysm | [[Heart failure]], [[Ventricular arrhythmias|ventricular arrhythmia]], mural [[thrombosis]], and ventricular rupture, are complications of LV aneurysm that may develop despite proper treatment of the underlying myocardial event. The overall prognosis is dependent on the size of the aneurysm, the presence of [[akinesia]], and the extent of the underlying cardiac event. | ||
==Natural History== | ==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.<ref name="pmid5659397">{{cite journal |vauthors=Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP |title=Clinical diagnosis and prognosis of ventricular aneurysm |journal=Br Heart J |volume=30 |issue=4 |pages=497–513 |year=1968 |pmid=5659397 |pmc=487659 |doi= |url=}}</ref> | If left untreated, it may lead to heart failure and persistent [[anginal]] pain. For false aneurysms, rupture and [[hemodynamic]] compromise are the usual outcomes if left untreated. Improvements in [[STEMI]] management, control of [[hypertension]], and avoidance of [[corticosteroids]] in [[STEMI]] have led to a better prognosis and decreased mortality.<ref name="pmid5659397">{{cite journal |vauthors=Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP |title=Clinical diagnosis and prognosis of ventricular aneurysm |journal=Br Heart J |volume=30 |issue=4 |pages=497–513 |year=1968 |pmid=5659397 |pmc=487659 |doi= |url=}}</ref> | ||
==Complications== | ==Complications== | ||
Line 13: | Line 13: | ||
It occurs in almost 50% of patients and can be detected by [[angiography]] or echocardiography.<ref name="pmid5659397">{{cite journal |vauthors=Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP |title=Clinical diagnosis and prognosis of ventricular aneurysm |journal=Br Heart J |volume=30 |issue=4 |pages=497–513 |year=1968 |pmid=5659397 |pmc=487659 |doi= |url=}}</ref> | It occurs in almost 50% of patients and can be detected by [[angiography]] or echocardiography.<ref name="pmid5659397">{{cite journal |vauthors=Mourdjinis A, Olsen E, Raphael MJ, Mounsey JP |title=Clinical diagnosis and prognosis of ventricular aneurysm |journal=Br Heart J |volume=30 |issue=4 |pages=497–513 |year=1968 |pmid=5659397 |pmc=487659 |doi= |url=}}</ref> | ||
===Heart failure=== | ===Heart failure=== | ||
Paradoxical movement in the aneurysmal portion of the LV wall reduces efficiency of the | Paradoxical movement in the aneurysmal portion of the LV wall reduces the efficiency of the ventricular contraction, and compromises the [[stroke volume]]. It may lead to LV dilation and an increase in LV end-diastolic pressure, this may be accompanied by [[chest pain]].<ref name="pmid3168193">{{cite journal |vauthors=Nicolosi AC, Spotnitz HM |title=Quantitative analysis of regional systolic function with left ventricular aneurysm |journal=Circulation |volume=78 |issue=4 |pages=856–62 |year=1988 |pmid=3168193 |doi= |url=}}</ref><ref name="pmid6024006">{{cite journal |vauthors=Klein MD, Herman MV, Gorlin R |title=A hemodynamic study of left ventricular aneurysm |journal=Circulation |volume=35 |issue=4 |pages=614–30 |year=1967 |pmid=6024006 |doi= |url=}}</ref> | ||
===Arrhythmia=== | ===Arrhythmia=== | ||
Approximately 15% have symptomatic [[ventricular arrhythmias]] that may be intractable and life-threatening.<ref name="pmid7008078">{{cite journal |vauthors=Waldo AL, Arciniegas JG, Klein H |title=Surgical treatment of life-threatening ventricular arrhythmias: the role of intraoperative mapping and consideration of the presently available surgical techniques |journal=Prog Cardiovasc Dis |volume=23 |issue=4 |pages=247–64 |year=1981 |pmid=7008078 |doi= |url=}}</ref> | Approximately 15% have symptomatic [[ventricular arrhythmias]] that may be intractable and life-threatening.<ref name="pmid7008078">{{cite journal |vauthors=Waldo AL, Arciniegas JG, Klein H |title=Surgical treatment of life-threatening ventricular arrhythmias: the role of intraoperative mapping and consideration of the presently available surgical techniques |journal=Prog Cardiovasc Dis |volume=23 |issue=4 |pages=247–64 |year=1981 |pmid=7008078 |doi= |url=}}</ref> | ||
===Ventricular rupture=== | ===Ventricular rupture=== | ||
Unlike false aneurysms, a mature true LV aneurysm rarely ruptures.<ref name="pmid1132088">{{cite journal |vauthors=Vlodaver Z, Coe JI, Edwards JE |title=True and false left ventricular aneurysms. Propensity for the altter to rupture |journal=Circulation |volume=51 |issue=3 |pages=567–72 |year=1975 |pmid=1132088 |doi= |url=}}</ref> | |||
==Prognosis== | ==Prognosis== | ||
Depending on the size of the aneurysm, extent of underlying cardiac event, presence of | Depending on the size of the aneurysm, the extent of the underlying cardiac event, the presence of complications, and the promptness of medical intervention, the prognosis may vary. However, the overall prognosis is improved by modern treatment and advanced management. | ||
==References== | ==References== |
Latest revision as of 04:28, 9 April 2017
Left ventricular aneurysm Microchapters |
Differentiating Left ventricular aneurysm from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Left ventricular aneurysm natural history, complications and prognosis On the Web |
American Roentgen Ray Society Images of Left ventricular aneurysm natural history, complications and prognosis |
FDA on Left ventricular aneurysm natural history, complications and prognosis |
CDC on Left ventricular aneurysm natural history, complications and prognosis |
Left ventricular aneurysm natural history, complications and prognosis in the news |
Blogs on Left ventricular aneurysm natural history, complications and prognosis |
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 complications of LV aneurysm that may develop despite proper treatment of the underlying myocardial event. The overall prognosis is dependent on the size of the aneurysm, the presence of akinesia, and the extent of the 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 usual outcomes if left untreated. Improvements in STEMI management, control of hypertension, and avoidance of corticosteroids in STEMI have led to a 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 the efficiency of the ventricular contraction, and compromises the stroke volume. It may lead to LV dilation and an increase in LV end-diastolic pressure, this 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
Unlike false aneurysms, a mature true LV aneurysm rarely ruptures.[5]
Prognosis
Depending on the size of the aneurysm, the extent of the underlying cardiac event, the presence of complications, and the promptness of medical intervention, the prognosis may vary. However, the overall prognosis is 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.