Ventricular Aneurysm - Types, Causes, Symptoms, and Treatment

Introduction

An aneurysm is an outwards bulging defective artery (blood vessel) wall due to excessive expansion. A ventricular aneurysm is a defect in the ventricle (one of the chambers of the heart) of the heart characterized by a blood-filled bulge that occurs due to a weakened area of the heart wall. The ventricular aneurysm is generally seen in the left ventricle and is often called a left ventricular aneurysm. It occurs as a complication in about five to ten percent of patients with myocardial infarction (heart attack) that can result in heart failure and shock. The ventricular aneurysm is more common in cases where a heart attack affects the entire thickness of the heart muscle.

What Are the Types of Ventricular Aneurysms?

1. True Ventricular Aneurysm - In this condition, a blood-filled sac forms in the weakened area of the heart wall due to damage to the wall.

2. False Ventricular Aneurysm - It is also called pseudoaneurysm, as the damage to the ventricular wall allows blood to collect in the pericardium (the membrane surrounding the heart).

What Are the Causes of Ventricular Aneurysms?

Heart attacks are the major cause of ventricular aneurysms, causing the heart muscles to die. Scar tissue forms on the damaged part, and over time this scar tissue stretch and becomes thin, leading to a weakened area of the heart muscle. Rarely ventricular aneurysms can occur as a birth defect and may go undiagnosed until it causes problems later in life. Less common causes include:

• Rheumatic fever (inflammatory disease affecting the heart, blood vessels, and joints).

• Endocarditis (an infection of the inner lining of the heart).

• Sarcoidosis (an inflammatory disorder characterized by abnormal collections of inflammatory cells).

• Overuse of NSAIDs (nonsteroidal anti-inflammatory drugs) or steroids.

• Syphilis (bacterial infection transmitted through sexual contact).

• Tuberculosis (serious bacterial infection affecting lungs).

• Complications of open heart surgery.

• Traumatic accidents.

• Apical hypertrophic cardiomyopathy (abnormally thick heart muscle at the apex of the heart).

What Are the Signs and Symptoms of a Ventricular Aneurysm?

Generally, symptoms are not experienced if the weakened area is small. The symptoms experienced include:

• Heart palpitations.

• Chest pain or pressure.

• Fatigue.

• Shortness of breath.

• Fluid retention (edema) causes swelling in the legs and abdomen.

• Stroke due to blood clot.

What Are the Risks Factors of Ventricular Aneurysm?

The risk factors contributing to the development of a ventricular aneurysm include:

• Gender - Men are more affected by ventricular aneurysms than women.

• Age - Most ventricular aneurysms develop in people of age over 65.

• Family History - People with a family history of heart disease or heart attacks are at a greater risk of developing ventricular aneurysms.

• Hypertrophic Cardiomyopathy - It is a result of a genetic condition causing cells of the heart muscle to enlarge and thicken ventricle walls increasing the risk of ventricular aneurysms.

How to Diagnose Ventricular Aneurysms?

Patients with ventricular aneurysms do not always show symptoms. If they have experienced a heart attack or have any other associated concerns, the doctor may recommend the following tests:

• Chest X-Ray - In a slightly oblique view of the chest X-ray, a ventricular aneurysm forms a well-circumscribed opacity forming beyond the regular outline of the heart. In lateral view, it forms an oval or round shadow superimposed by that of the heart.

• Echocardiography - Two-dimensional echocardiography helps in a clear demonstration of a ventricular aneurysm. This test helps to differentiate between true and false ventricular aneurysms.

• Electrocardiography - This test can determine the damaged, enlarged, or overworked parts of the heart by measuring the electrical activity of the heart.

• Angiography - For diagnosing a left ventricular aneurysm site, left ventriculography is the new gold standard and accurate test. It also shows any blood clots or other blood vessel problems.

• Computed Tomography (CT) Scan - CT scan is a reliable diagnostic test for ventricular aneurysms. It gives a better view of the aneurysm wall.

• MRI (Magnetic Resonance Imaging) Scan - MRI scan helps delineate the aneurysm's bulging and shows the scar tissue's location and extent.

What Are the Treatment Options for Ventricular Aneurysms?

The ventricular aneurysm can be treated medically and surgically. The treatment plan depends on the location and size of the ventricular aneurysm and the overall health of the patient.

1. Lifestyle Changes - Lifestyle changes such as limiting physical activity, avoiding overexertion and stress, and maintaining a healthy diet can be helpful in patients with small aneurysms, not constricting blood flow. Following such lifestyle changes can help reduce the risk of complications and prevent the aneurysm from getting bigger in size.

2. Medications - The medicines that the doctor can prescribe include:

• Anti-coagulants - These are given to prevent blood clot formation.

• Vasodilators - They help to dilate the blood vessels, reducing the blood pressure and making blood flow easier.

• Statins - These medicines help in lowering cholesterol levels.

3. Surgery - Ventricular reconstructive surgery or ventricular remodeling is suggested for larger ventricular aneurysms that cause serious pain or other symptoms of heart failure. This procedure is generally done through open-heart surgery. This procedure is one to remove the aneurysm, alleviating the symptoms and restoring normal function. A biological or synthetic patch can be used, or healthy parts of the heart can be sewn together, depending on the shape and size of the aneurysms. Cardiac rehabilitation programs may be suggested for those who have had a heart attack or are diagnosed with a ventricular aneurysm. This program provides an exercise regimen designed to strengthen the heart and offers guidance on other diet and lifestyle changes that help reduce the risk of another heart attack, heart failure, and other associated complications.

What Are the Complications of Ventricular Aneurysms?

The complications of ventricular aneurysms include:

• Ruptured aneurysm.

• Blood clots and strokes.

• Ventricular tachycardia (rapid and abnormal heart rhythm).

• Myocardial ischemia (reduced oxygen-rich blood flow to the heart muscle).

• Cardiogenic shock (a condition in which the heart is unable to pump enough blood to meet the body’s needs).

• Heart failure.

How to Prevent Ventricular Aneurysms?

Some ways to prevent ventricular aneurysms include:

• Avoid unhealthy fat intake, and reduce salt and sugar in the diet.

• 30 minutes of exercise every day can help prevent heart attacks.

• Avoid the use of tobacco and cocaine.

• Reduce alcohol intake.

• Take prescribed medicines on time and regularly.

• Get regular checkups done if at risk.

Conclusion:

A ventricular aneurysm is usually seen in people who have experienced a heart attack, although it can also develop in others. There are ways to prevent it, but those with unpreventable risks like age and genetics should go for regular screenings. Early and prompt diagnosis can help get immediate treatment and save people's lives.