Left ventricular pseudoaneurysm
Background
- Acute MI or surgical mishap causes ventricular free wall rupture [1]
- Contained by pericardial adhesions
- Mortality rate high secondary to rupture of pseudoaneurysm
Causes
- Transmural MI (anterior or inferior most common)
- Surgical mishap
Clinical Features
- 10% are asymptomatic [2]
- History of MI or cardiac surgery
- Symptoms similar to congestive heart failure
- Angina
- Shortness of breath
- New cardiac murmur (70%)
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Pneumomediastinum
- Pneumothorax
- Pulmonary embolism
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Cocaine chest pain
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Drugs of abuse (eg, cocaine, crack, meth)
- Medications
Evaluation[3]
- ECG
- Non-specific ST changes
- ST elevation (20%)
- CXR
- Mass-like appearance
- LV angiography
Management
- Surgical repair = 10% 5 yr mortality
- Medical therapy = 50% 5 yr mortality
Complications
- Angina (increased O2 demand)
- Complete LV rupture
See Also
- Frances, C., Romero, A., and Grady, D. (1998). Left ventricular pseudoaneurysm. Journal of the American College of Cardiology; 32(3): 557 - 61
- Frances, C., Romero, A., Grady, D. (1998). Left ventricular pseudoaneurysm. Journal of the American College of Cardiology, 32(3); 557 - 61
- Frances, C., Romero, A., Grady, D. (1998). Left ventricular pseudoaneurysm. Journal of the American College of Cardiology, 32(3); 557 - 61
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