Left Ventricular Aneurysm

What is left ventricular aneurysm?

A left ventricular aneurysm is a bulge or ballooning of a weakened area of the heart. The left lower chamber of the heart (left ventricle) pumps blood returning from the lungs to the rest of the body. The muscle of the left ventricle is normally about a half-inch thick.

How does it occur?

When a blockage of a heart artery cuts off blood supply to a part of the heart for a long time, the heart muscle in that area dies. Atherosclerosis (fat buildup in the arteries) is the usual cause of blockage. Most people with blocked coronary arteries do not develop an aneurysm.

When part of the heart muscle dies, healing usually takes place by forming a scar where the heart was damaged. Sometimes the scar thins and stretches. It bulges outward much like a weak spot on a car tire. Unlike the tire, it rarely bursts, but its location and size may greatly reduce the heart's pumping ability. This bulge is called a left ventricular aneurysm.

Up to 25% of people with a large area of heart muscle death from a heart attack develop aneurysms. The aneurysms range from very small (thumbnail size) to huge (doubling the size of the heart). Aneurysms usually form and get bigger during the first few months after a heart attack. Why they form in some people and not in others is not known.

What are the symptoms?

Heart failure, the inability of the heart to pump effectively, is a severe complication of a large left ventricular aneurysm. The remaining normal heart muscle must not only pump blood to the body but it must fill the aneurysm as well. When this added load is too great for the muscle, it is called heart failure.

Blood clots often form in left ventricular aneurysms. Fragments of these clots sometimes break away and are carried through the bloodstream to other organs. They may become stuck in the blood vessels and cause strokes or other organ damage.

Left ventricular aneurysms may cause heart rhythm problems. A very fast heart rate called ventricular tachycardia may make heart failure worse or lead to sudden death.

How is it diagnosed?

Your symptoms will suggest problems with the pumping ability of the heart. You probably will have an echocardiogram, a test that uses ultrasound waves to take pictures of the heart. The aneurysm is easily detected. Its size and its effect on the ability of the heart muscle to squeeze is measured.

Cardiac catheterization may be needed. Cardiac catheterization is a test in which a long, thin tube is pushed through the blood vessels into the heart. X-ray movies of dye flowing through the heart will outline the aneurysm and the coronary arteries. The test gives detailed information about the inner workings of the heart.

How is it treated?

Many left ventricular aneurysms are small and need no treatment. Some may interfere only slightly with heart function and can be treated with medicines for heart failure. Some aneurysms may even be prevented by the use of proper medicine during a heart attack. Anticoagulants (blood thinners) are used to prevent blood clots. People with heart aneurysms also frequently have heart rhythm problems. You may receive medicines to treat this problem or may have a device called a defibrillator put in.