Ventricular Aneurysm: Pathophysiology

Ventricular aneurysm
Pathophysiology
The transmural myocardial infarction due to the occlusion of either the left anterior descending artery
or the dominant right coronary artery leads to the formation of a true left ventricular aneurysm. Two
principal mechanisms are involved in its formation, the early expansion phase and the late remodeling
phase.
Early Expansion Phase
A true left ventricular aneurysm following acute myocardial infarction can occur as early as 48 hours or
two weeks post-infarction.
Within hours of the infarction, the gross thinning of the infarct zone occurs. The migration of
inflammatory cells in the infarct zone occurs by 2 to 3 days post-infarction. They contribute to the lysis
of the necrotic myocytes by 5 to 10 days. Some viable myocytes are often present in the infarct area.
There is a disruption of the collagen fibers, and along with the necrotic myocytes, it forms the nadir of
myocardial tensile strength. Usually, in the infarcted zone, an extravascular hemorrhage can occur,
leading to the decreased diastolic and systolic function of the heart. The factors contributing to the
formation of the left ventricular aneurysm in the early phase include:
 Preserved contractility of the surrounding myocardium

 Transmural infarction
 Lack of collateral circulation
 Lack of reperfusion
 Elevated wall stress
 Hypertension
 Ventricular dilatation
 Wall thinning
Late Remodeling Phase
About 2 to 4 weeks post-infarction, remodeling of the myocardium begins with the appearance of highly
vascularized granulation tissue. It is replaced by fibrous tissue 6 to 8 weeks post-infarction. As
myocardium becomes replaced by fibrous tissue, it greatly decreases the ventricular wall thickness due
to the loss of myocytes.
Clinical manifestation
Small aneurysms are usually asymptomatic and are typically diagnosed by routine investigations.
However, large aneurysms present with signs and symptoms of thromboembolism, wall motion
abnormalities, contractility defects, arrhythmias, and sudden cardiac death. Common symptoms
associated with the ventricular aneurysm include:
 Fatigue
 Shortness of breath
 Chest pain
 Palpitations
 Syncope
 Fluid retention causing swelling of ankles, feet, or abdomen
 Stroke, or thromboembolic phenomenon to any organ in the body
 Limb or visceral ischemia
Physical Exam
Clinical examination of the cardiovascular system reveals abnormalities pertinent to associated

complications with the ventricular aneurysm. The physical signs which should suspect the presence of
ventricular aneurysm include:
 Tachycardia
 Arrhythmias
 Pericardial rub
 Abnormalities of cardiac impulse
 Paradoxical splitting of the S2
 S3 heart sound
 Pedal edema
 Fine inspiratory basal crept
 Murmurs
Treatment and Recovery

Ventricular aneurysm treatment depends on the aneurysm’s size, location and your overall health.
Lifestyle Changes
If the aneurysm is small and not significantly constricting blood flow, then your doctor may recommend
lifestyle changes. Limiting physical activity, avoiding stress and overexertion and maintaining a heart-
healthy diet can reduce the risk of complications associated with ventricular aneurysms and prevent the
aneurysm from getting bigger.
Medication
If you are diagnosed with a ventricular aneurysm, your doctor may prescribe an anti-coagulant to
prevent the formation of blood clots. Other medications that may be prescribed include:
Statins: Statins are a class of drug that help lower cholesterol levels.
Vasodilators: Vasodilators are drugs that dilate your blood vessels, lowering your blood pressure and
making it easier for blood to flow.
Ventricular Reconstructive Surgery
For larger aneurysms causing serious pain and other symptoms of heart failure, your cardiologist may
recommend ventricular reconstructive surgery, or ventricular remodeling. This is usually done through
open heart surgery with the purpose of removing the aneurysm, relieving symptoms and restoring
proper function. Depending on the size and shape of the aneurysm, a synthetic or biological patch may
be used, or the healthy areas of the heart may be sewn together directly. Like most types of open heart
surgery, ventricular reconstructive surgery usually requires a hospital stay of a week or more, and the
recovery process can take many months.
Cardiac Rehabilitation Programs
If you have had a heart attack or are diagnosed with a ventricular aneurysm, your doctor will likely
recommend a cardiac rehabilitation program. These programs provide an exercise regimen specifically
designed to help you slowly strengthen your heart, and offer guidance on other diet and lifestyle
changes that will help reduce your risk of another heart attack, heart failure and other complications.

Ventricular Aneurysm: Pathophysiology

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Ventricular Aneurysm: Pathophysiology

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Ventricular aneurysm

Early Expansion Phase

 Preserved contractility of the surrounding myocardium

Late Remodeling Phase

Clinical examination of the cardiovascular system reveals abnormalities pertinent to associated

Treatment and Recovery

Ventricular Reconstructive Surgery

Cardiac Rehabilitation Programs

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