From the Guidelines
Left ventricular aneurysmectomy is indicated in patients with large, discrete left ventricular aneurysms who develop heart failure, and may be considered in carefully selected patients with heart failure with reduced ejection fraction (HFrEF) for specific indications, including intractable heart failure and ventricular arrhythmias 1.
Treatment Overview
A left ventricular aneurysm is a weakened, bulging area in the wall of the left ventricle of the heart that develops after a heart attack. It occurs when damaged heart muscle tissue is replaced by scar tissue, which doesn't contract properly during heartbeats. Treatment depends on symptoms and size, ranging from medication management to surgical intervention.
Medication Management
For asymptomatic small aneurysms, medications typically include:
- Anticoagulants like warfarin to prevent blood clots
- Beta-blockers such as metoprolol (25-200 mg daily) to reduce heart workload
- ACE inhibitors like lisinopril (10-40 mg daily) to lower blood pressure
- Statins to manage cholesterol
Surgical Intervention
For larger or symptomatic aneurysms causing heart failure, arrhythmias, or embolic events, surgical repair may be necessary through aneurysmectomy (removal) or ventricular reconstruction, as recommended by the 2013 ACCF/AHA guideline for the management of heart failure 1.
Lifestyle Modifications
Regular cardiac monitoring with echocardiograms every 6-12 months is essential to track aneurysm size and ventricular function. Lifestyle modifications including:
- Sodium restriction
- Moderate exercise as tolerated
- Smoking cessation
- Stress management are crucial components of management. Left ventricular aneurysms require attention because they can lead to heart failure, arrhythmias, and blood clots that may cause strokes or other embolic events if left untreated.
From the Research
Definition and Causes of Left Ventricular Aneurysm
- A left ventricular aneurysm is a complication of a heart attack, where a portion of the heart muscle weakens and balloons outward, disrupting the heart's normal functioning 2.
- The aneurysm can be caused by a significant lesion of one or more coronary arteries, leading to a lack of blood flow to the heart muscle 2.
Symptoms and Diagnosis
- Symptoms of a left ventricular aneurysm may include angina, congestive heart failure, and intractable ventricular arrhythmias 2.
- Diagnosis can be made using echocardiography, cardiac magnetic resonance (CMR), or other imaging techniques to visualize the aneurysm and assess heart function 2, 3.
Treatment Options
- Surgical treatment, such as left ventricular aneurysmectomy, can be effective in improving clinical status, hemodynamics, and long-term longevity 2.
- The use of angiotensin-converting enzyme inhibitors (ACE-I) has been shown to prevent late remodeling after left ventricular aneurysm repair and improve left ventricular systolic function 4.
- Different surgical techniques, such as reconstructive surgery, can be used to reverse adverse left ventricular remodeling due to postinfarction left ventricular aneurysm 5.
Complications and Management
- Left ventricular thrombus is a serious complication of left ventricular aneurysm, and anticoagulant therapy may be necessary to reduce the risk of systemic embolism and stroke 3.
- The use of ACE inhibitors, such as lisinopril, can help to lower blood pressure and reduce the risk of complications associated with left ventricular aneurysm 6.