Left ventricular aneurysm - Revision history

ClaireLewis at 15:32, 25 September 2019

2019-09-25T15:32:18Z

← Older revision		Revision as of 15:32, 25 September 2019
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	*May be asymptomatic		*May be asymptomatic
	*History of [[myocardial infarction]]		*History of [[myocardial infarction]]
	*Angina		*[[Angina]]
	*Shortness of breath or dyspnea on exertion		*[[Shortness of breath]] or dyspnea on exertion
	*[[CHF]] symptoms		*[[CHF]] symptoms
	*Mitral regurgitation murmur		*Mitral regurgitation [[murmur]]
	*S3/S4 heart sounds		*S3/S4 heart sounds
	*More common in women than men		*More common in women than men


			===Complications===
			*[[Heart failure]] (LV aneurysm steals cardiac output)
			*[[Angina]] (increased O2 demand)
			*[[Ventricular dysrhythmias]] (LV stretch/scarring)
			*LV thrombus (50% of time), arterial embolism (stroke)
			*[[cardiac rupture\|LV rupture]] (rarely occurs in mature LVA because of dense fibrosis)

	==Differential Diagnosis==		==Differential Diagnosis==
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	**Calcified aneurysm		**Calcified aneurysm
	**May have mass-like appearance		**May have mass-like appearance
	*TTE		*[[echocardiography\|TTE]]
	*LV angiography		*LV angiography
	*Cardiac MRI		*Cardiac MRI
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	==Disposition==		==Disposition==
	*Cardiothoracic surgery consultation		*Cardiothoracic surgery consultation

	~~==Complications==~~
	*Heart failure (LV aneurysm steals CO)
	*Angina (increased O2 demand)
	*Ventricular arrhythmias (LV stretch/scarring)
	*LV thrombus (50% of time), arterial embolism (stroke)
	*LV rupture (rarely occurs in mature LVA because of dense fibrosis)

	==See Also==		==See Also==

2019-08-14T02:24:58Z

Workup

← Older revision		Revision as of 02:24, 14 August 2019
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	**Persistent characteristic ST elevation after MI		**Persistent characteristic ST elevation after MI
	**Non-specific ST segment changes		**Non-specific ST segment changes
			**Q or QS waves
			**T waves small relative to QRS
			**No reciprocal changes
	*[[CXR]]		*[[CXR]]
	**Prominent left heart border		**Prominent left heart border

2019-04-06T14:24:17Z

Diagnosis

← Older revision		Revision as of 14:24, 6 April 2019
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	===Diagnosis===		===Diagnosis===
	''Differentiate left ventricular aneurysm from STEMI''		''Differentiate left ventricular aneurysm from [[STEMI]] and other causes of [[ST-elevation]]''
	*Strongly suspect [[STEMI]] if:		*Strongly suspect [[STEMI]] if:
	**Symptomatic		**Symptomatic
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	***If any lead in V1-V4 has T-wave amplitude to QRS amplitude ratio > 0.35		***If any lead in V1-V4 has T-wave amplitude to QRS amplitude ratio > 0.35
	***Suggestive of STEMI, with ~89% accuracy		***Suggestive of STEMI, with ~89% accuracy

			{{STEMI Stages of Development}}

	==Management==		==Management==

2019-04-06T14:22:05Z

Evaluation

← Older revision		Revision as of 14:22, 6 April 2019
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	[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]		[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]
	*[[ECG]]		*[[ECG]]
			**Persistent characteristic ST elevation after MI
			**Non-specific ST segment changes
	*[[CXR]]		*[[CXR]]
	**Prominent left heart border		**Prominent left heart border
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	===Diagnosis===		===Diagnosis===
	*Differentiating left ventricular aneurysm from STEMI ~~on ECG~~		''Differentiate left ventricular aneurysm from STEMI''
	**Persistent characteristic ST elevation after MI		*Strongly suspect [[STEMI]] if:
	**Non-specific ST segment changes
	*Strongly suspect [[STEMI]] if
	**Symptomatic		**Symptomatic
	**No [[q waves]] present (LV aneurysm typically produces significant q waves)		**No [[q waves]] present (LV aneurysm typically produces significant q waves)

2019-04-06T14:19:37Z

Evaluation

← Older revision		Revision as of 14:19, 6 April 2019
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	==Evaluation==		==Evaluation==
			===Workup===
	[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]		[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]
	*[[ECG]]		*[[ECG]]

2019-04-06T14:19:23Z

Evaluation

← Older revision		Revision as of 14:19, 6 April 2019
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	==Evaluation==		==Evaluation==
	[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]		[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]
			*[[ECG]]
	*[[CXR]]		*[[CXR]]
	**Prominent left heart border		**Prominent left heart border
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	*LV angiography		*LV angiography
	*Cardiac MRI		*Cardiac MRI
	*[[ECG]]
			===Diagnosis===
			*Differentiating left ventricular aneurysm from STEMI on ECG
	**Persistent characteristic ST elevation after MI		**Persistent characteristic ST elevation after MI
	**Non-specific ST segment changes		**Non-specific ST segment changes

2019-04-06T14:18:00Z

Management

← Older revision		Revision as of 14:18, 6 April 2019
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	===Medical Therapy (first line)===		===Medical Therapy (first line)===
	*Afterload reduction (ACEI)		*Afterload reduction ([[ACEI]])
	*Antianginal (Nitro)		*Antianginal ([[Nitro]])
	*Anticoagulation (if LV thrombus)		*[[Anticoagulation]] (if LV thrombus)

	===Surgical Therapy===		===Surgical Therapy===

2019-04-06T14:14:17Z

Background

← Older revision		Revision as of 14:14, 6 April 2019
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	==Background==		==Background==
	[[File:Heart left ventricular aneurysm sa.jpg\|thumb\|~~Heart left~~ ventricular aneurysm as thinned wall in upper right of picture (short axis view)]]		[[File:Heart left ventricular aneurysm sa.jpg\|thumb\|Left ventricular aneurysm: thinned wall in upper right of picture (short axis view)]]
			[[File:Heart lv aneurysm 4c.jpg\|thumb\|eft ventricular aneurysm: thinned wall bottom right of picture (long axis view)]]
	*Thin or fibrotic ventricular wall		*Thin or fibrotic ventricular wall
	**Muscle may be absent or necrotic		**Muscle may be absent or necrotic

2019-04-06T14:11:15Z

← Older revision		Revision as of 14:11, 6 April 2019
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	==Background==		==Background==
			[[File:Heart left ventricular aneurysm sa.jpg\|thumb\|Heart left ventricular aneurysm as thinned wall in upper right of picture (short axis view)]]
	*Thin or fibrotic ventricular wall		*Thin or fibrotic ventricular wall
	**Muscle may be absent or necrotic		**Muscle may be absent or necrotic

2019-04-06T14:08:36Z

Evaluation

← Older revision		Revision as of 14:08, 6 April 2019
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	==Evaluation==		==Evaluation==
			[[File:LeftvAneurysmCrop.jpg\|thumb\|ECG of left ventricular aneurysm. Note the ST elevation in the anterior leads.]]
	*[[CXR]]		*[[CXR]]
	**Prominent left heart border		**Prominent left heart border