A post-infarction aneurysm is an abnormal bulging of the heart wall in the area of ​​the infarction. This complication occurs on average in 3-15% of patients who have had a heart attack. How does a post-infarction aneurysm develop? How is it manifested? What does the diagnosis look like? What is the procedure?

Post-infarction aneurysmis a relatively late complication of myocardial infarction, i.e. myocardial necrosis due to ischemia (most often caused by a sudden closure of the flow in the coronary artery). In the infarcted area, a healing process takes place in which the area of ​​necrosis is replaced by connective tissue - a scar is formed. It is mechanically insufficiently flexible, which means that the constant work of the heart (contraction and diastole) makes this part of the heart bulge.

The vast majority of post-infarction aneurysms are located within the anterior wall of the left ventricle, often involving the apex of the heart. They are a consequence of a full-walled infarction caused by the closure of the lumen of the left anterior descending artery (LAD). More rarely, an aneurysm develops in the lower wall of the heart.

Post-infarction aneurysm - symptoms

Complication of a heart attack in the form of a heart aneurysm has specific, serious consequences.

  • An aneurysm is a site of decreased contractility, which can in turn significantly (especially if the aneurysm is large) impair ventricular systolic function and cause symptoms of heart failure.
  • In an aneurysm, blood "stagnates" very often. This favors the formation of the so-called wall clots. Such a thrombus may detach and follow the bloodstream, causing embolic complications. The most dangerous of them is ischemic stroke.
  • The post-infarction scar within the aneurysm may be the focus of dangerous ventricular arrhythmias, which can lead to the so-called sudden cardiac death.
  • Not infrequently, patients with aneurysms also complain of angina-like pains.

Post-infarction aneurysm - diagnosis

The test of choice that detects and confirms the diagnosis of a post-infarction aneurysm is the heart echo, i.e. echocardiographic examination. The presence of a heart aneurysm may also be suggested by an ECG (electrocardiogram), vwhich may significantly be persistent ST-segment elevations in precordial leads (usually in V2-V4). The elevations should retreat after the infarction has been made. The persistence of such a change in the longer period after the MI, prompts the in-depth diagnosis.

Post-infarction aneurysm - treatment

The mainstay of post-infarction aneurysm treatment is cardiac surgery. In simple terms, it consists in removing an abnormal part of the ventricle along with a possible thrombus. The resulting cavity is filled with a circular, Dacron patch. The technique of left ventricular plastic surgery is constantly being modified so that the long-term treatment results and the hemodynamic parameters of the heart are the best.

Conservative treatment is an auxiliary and alternative for patients who are not eligible for surgery, including: treatment of heart failure, arrhythmias, and anticoagulant treatment, aimed at reducing thrombus formation and preventing thromboembolic events.

Category:

Cardiology