Ventricular Aneurysm

A 72-year-old woman who had fallen and injured the left side of her chest came to the emergency department complaining of pain in that area. She was physically stable and not short of breath. A soft systolic murmur was heard over the left precordium; the lungs were clear. A posteroanterior chest film showed no rib fracture but it did show an enlarged heart and a large, calcified ventricular aneurysm (arrow).

Ventricular aneurysm is characterized by extreme thinning of the cardiac wall and a convex deformity of the external surface. This aneurysm is frequently associated with transmural infarctions, and it involves the anterior or apical area in 80% of patients. A chest film may disclose a bulge on the lower left ventricular contour, and calcium is commonly noted within the aneurysm wall.

Major complications of this condition include congestive heart failure, ventricular tachycardia, and arterial embolism. Rupture rarely occurs unless there is reinfarction at the site of the aneurysm. The prognosis is contingent on the size of the aneurysm, the function of the remaining myocardium, and the severity of coronary artery disease.