Aneurysm of the heart

- swelling of a limited area of the thinned wall of the left ventricle.

In most cases, the aneurysm is localized on the anterior wall at the top of the heart; an aneurysm of the interventricular septum bulges into the cavity of the right ventricle (where the pressure is less than in the left). False aneurysms are distinguished from true heart aneurysms a special form of myocardial rupture ; the wall of a false aneurysm is the pericardium .


The etiology and pathogenesis of aneurysm of the heart

Aneurysm usually forms within 3 months after an anterior transmural myocardial infarction. An acute aneurysm develops in the acute stage of myocardial infarction, when the necrotic area softens and, under the influence of increased pressure during systole, swells outwards or, when the interventricular septum is damaged, into the cavity of the right ventricle.

As the scarring of a myocardial infarction, an acute aneurysm disappears or turns into a chronic one , a certain role is played by the remaining occlusion of the coronary artery and insufficient collateral blood flow.

Aneurysm leads to a decrease in cardiac output – part of the shock volume falls into its cavity. In the aneurysm cavity, blood clots are often formed, which can become a source of thromboembolism of the arteries of the large circulatory circle.

Symptoms and course of a heart neurism

Aneurysm of the heart can be asymptomatic, but it often causes heart rhythm disorders, heart failure, and a source of thromboembolism. During examination, precordial pulsation, expansion of the heart borders, and systolic noise can be detected.

Radiologically, it is often possible to detect local protrusion of the heart contour. Characteristic changes in the ECG are a pathological o wave and a persistent St segment elevation in the thoracic leads (a frozen monophase curve). 


The diagnosisof an aneurysm of the heart

It is confirmed by echocardiography, which reveals a section of left ventricular dyskinesia, thinning of its wall, and in some cases, parietal thrombosis.

Treatment of a heart neurism

With increasing left ventricular failure, life-threatening heart rhythm disorders (episodes of ventricular tachycardia), recurrent thromboembolism, surgical excision of the aneurysm (aneurysmectomy) is performed. In the case of a false aneurysm due to the high probability of its rupture, surgical treatment is also indicated.