Aneurysm of the left ventricle is a scar tissue that forms in the area of the myocardium in which necrotic or inflammatory processes are localized. The mechanism of development of aneurysm is as follows. Normal muscle tissue is represented by smooth muscle fibers that perform contractile function.
In order to contract at full strength, the fibers need an uninterrupted supply of oxygen with blood flowing through the coronary arteries. In case of artery blockage, an acute shortage of oxygen in the heart muscle (hypoxia) occurs and necrosis, or death of heart cells, develops. The heart muscle in this area of necrosis turns into “soft” tissue (a process called myomalacia), and the wall of the heart is not able to withstand the high pressure of the blood pumped into the ventricle from the atrial cavity.
The formation of postinfact LV aneurysm
In addition to acute heart attack, an aneurysm of the left ventricle can be formed with the development of post-infarction cardiosclerosis. Cardiosclerosis is a process of development of connective tissue (scar) fibers in place of dead cardiomyocytes. In other words, a scar forms in the heart, which normally should not be. In the event that myocardial infarction was extensive, transmural or circular, the scar tissue in the heart becomes too much, but it cannot withstand the loads that the powerful heart muscle experiences.
Not only cardiomyocyte necrosis can lead to the formation of scar tissue in the heart. Acute or chronic inflammatory processes in the heart muscle also lead to thinning of the heart wall due to connective tissue. Such processes are called myocarditis, and they can be caused by anything. Most often, myocarditis is caused by viruses (influenza, chickenpox, typhoid, etc.), bacteria (syphilis, streptococci, staphylococci, pneumococci, etc.), fungi, or caused by autoimmune inflammation in the heart muscle, such as, for example, in systemic lupus erythematosus or rheumatism .
The clinical picture of heart aneurysm is not strictly specific. In other words, there are no symptoms by which aneurysm can be clearly identified. However, the rapid progression of heart failure after an extensive myocardial infarction, its frequent decompensation may indicate the formation of protrusion in the heart wall.
- The rapid development (within several weeks and months) of left ventricular failure, which is manifested by an increase in shortness of breath during physical activity and at rest, intensifying in the supine position. The patient’s tolerance to normal household loads decreases – the patient after a heart attack cannot tie shoelaces, cook food, and calmly go into another room without shortness of breath.
- In a myocardial infarction with an aneurysm, the patient in the acute period has frequent attacks of acute left ventricular failure, manifested by episodes of cardiac asthma (dry obsessive cough and rapid breathing) and / or pulmonary edema (wet cough with foaming sputum, blue skin and other signs).
- The rapid attachment of right ventricular failure, which is manifested by swelling of the lower extremities. The patient’s stomach can grow in just a few days, due to stagnation of blood in the liver and fluid effusion in the abdominal cavity (ascites). Edema can spread throughout the body (anasarca).
If such symptoms appear, the patient should immediately contact a clinic or an ambulance for the purpose of further examination and treatment.
The tactics for treating aneurysm can be expectant or surgical. In the first case, the patient is monitored dynamically – once every six months or once a year he needs to visit a cardiologist with an ECG, chest x-ray and ultrasound of the heart. With increasing sizes of the aneurysm, or with the appearance of severe symptoms that significantly violate the quality of life, the patient may require cardiac surgery.
Medium (several centimeters) and gigantic aneurysms, when the protrusion in volume is comparable to the cavity of the left ventricle itself, requires surgery. In this case, the operation can be performed both without an incision in the heart wall, and on an open heart using a cardiopulmonary bypass (AIK).
The technique of the operation consists in suturing the aneurysm, in strengthening (plastic) the aneurysm with other tissues, or in resection of the aneurysm.
- In the first case, the protrusion is not opened, but as if immersed in the wall of the heart with the help of sutures that fix it to the myocardium itself. Such an operation is used for medium-sized aneurysms, which do not bulge outward and do not rise much above the surface of the heart. Operational access does not require opening the wall of the heart.
- In the second case, the aneurysm is not removed, and a flap from the diaphragm is sutured to the heart wall, the nutrition of which is carried out using the vascular pedicle. An incision of the heart wall is not required, and the operation is applicable for medium-sized aneurysms, which diffusely covers the myocardium, and also does not rise much above the outer surface of the heart. Operational access to the diaphragm and to the heart is carried out through a section of the chest in the sixth intercostal space on the left with the opening of the pleural and pericardial cavities.
- Aneurysm resection is a radical (that is, permanently removing the aneurysm) treatment method – the aneurysm wall is excised, part of it is removed and sutured with special sutures. The operation is performed on an open heart, using AIK. After prompt access and suturing on the aneurysmal bag, it is important to open the aneurysm dome and suture as soon as possible (usually the cardiac surgeon performs this procedure in 40-60 seconds). The remaining time is the closure of the defect in the wall of the heart and the imposition of a diaphragmatic flap.
After the operation, the patient should be in the cardiac surgery department for several days in order to observe and prevent postoperative complications.lt;
The symptoms of the disease in question will depend on the size of the aneurysm. Aneurysms of small parameters may not manifest themselves externally. More striking in terms of manifestations, more dangerous to health are large aneurysms.
In such cases, a number of symptoms may occur.
- Pathological pulsation diagnosed on the 2nd day after a heart attack. When listening to the patient (in the “lying” position), such a pulsation will resemble the sound of a “swinging wave”. Pathological tremors can be determined visually, by palpation. About 50% of patients have this symptom.
- Parietal thrombi. A characteristic sign of chronic heart aneurysm. Their creation is associated with malfunctions in the blood circulation. In the presence of parietal thrombi, pathological pulsation will be absent.
- Heart rhythm disturbance. A frequent occurrence with aneurysm of the heart is a rapid heartbeat (“gallop of the heart”).
What complaints do patients have?
- Serious heart errors
- Shortness of breath, which can provoke pulmonary edema, asthma.
- Failures in the heart rhythm: tachycardia, tachycardia, bradycardia, extrasystole, blockade.
- Angina pectoris (in active / inactive state).
- Swelling of the neck, face, upper limbs.
- Bloating veins on the neck.
- Repeated myocardial infarction, kidney infarction, gangrene of the extremities with advanced forms of the disease.
- Violations of the general condition of the body
- Increased body temperature.
- Constant fatigue, drowsiness.
- Errors in the work of the respiratory system:
- Chest pains that are regular.
- Headaches, dizziness.
The rupture of the aneurysm of the heart, often ending in the death of the patient, has its manifestations
- Change in skin color: pallor is replaced by cyanosis.
- Strong bloating of veins on the neck.
- Nausea, severe vomiting with impurities of blood.
- Cold sweat.
- Loss of consciousness.
- Hoarse breathing.
Almost 95% of cases of cardiac aneurysm occur as a result of myocardial infarction, mainly when it developed in the left ventricle. Such a ventricular aneurysm does not always develop immediately (we will consider the classification of the disease below), it can be provoked by such phenomena in the post-infarction period as:
- arterial hypertension;
- a large amount of fluid used;
- physical activity causing tachycardia;
- recurrent myocardial infarction.
Signs of a cardiac aneurysm can vary significantly: this is due to its size, localization, and cause of formation. It is generally difficult for a person who has had myocardial infarction to navigate in his condition, so the disease changes him. Meanwhile, an aneurysm is formed in almost one in ten people in the post-infarction period, and it is impossible to predict its appearance. Therefore, the task of each patient is to pay attention to the slightest change in health, and inform the attending cardiologist about it.
In 95-97% of cases, the cause of aneurysm of the heart is an extensive transmural myocardial infarction, mainly of the left ventricle. The vast majority of aneurysms are localized in the anterolateral wall and the apex of the left ventricle of the heart; about 1% – in the area of the right atrium and ventricle, interventricular septum and posterior wall of the left ventricle.
Massive myocardial infarction causes the destruction of the structures of the muscle wall of the heart. Under the influence of intracardiac pressure, the necrotic heart wall stretches and becomes thinner. A significant role in the formation of aneurysm belongs to factors contributing to an increase in the load on the heart and intraventricular pressure – early rising, arterial hypertension, tachycardia, repeated heart attacks, progressive heart failure. The development of chronic heart aneurysm is etiologically and pathogenetically associated with postinfarction cardiosclerosis. In this case, under the influence of blood pressure, the heart wall protrudes in the region of the connective tissue scar.
Much less often than post-infarction aneurysms of the heart, congenital, traumatic and infectious aneurysms are found. Traumatic aneurysms result from closed or open heart injuries. The same group includes postoperative aneurysms that often occur after operations to correct congenital heart defects (Fallot tetrads, pulmonary stenosis, etc.).
Aneurysms of the heart due to infectious processes (syphilis, bacterial endocarditis, tuberculosis, rheumatism) are very rare.
The clinical manifestations of acute cardiac aneurysm are characterized by weakness, shortness of breath with episodes of cardiac asthma and pulmonary edema, prolonged fever, excessive sweating, tachycardia, cardiac arrhythmias (bradycardia and tachycardia, extrasystole, atrial and ventricular fibrillation, blockades). With subacute aneurysm of the heart, symptoms of circulatory failure progress quickly.
The clinic of chronic aneurysm of the heart corresponds to pronounced signs of heart failure: shortness of breath, syncope, angina of rest and tension, a feeling of interruption in the work of the heart; in the late stage – neck vein swelling, edema, hydrothorax, hepatomegaly, ascites. With chronic aneurysm of the heart, fibrous pericarditis may develop, causing the development of adhesions in the chest cavity.
Thromboembolic syndrome in chronic aneurysm of the heart is represented by acute occlusion of the vessels of the limbs (most often the iliac and femoral-popliteal segments), brachiocephalic trunk, arteries of the brain, kidneys, lungs, intestines. Potentially dangerous complications of chronic aneurysm of the heart can be gangrene of the extremities, stroke, kidney infarction, pulmonary embolism, occlusion of mesenteric vessels, repeated myocardial infarction.
Rupture of chronic aneurysm of the heart is relatively rare. Rupture of acute cardiac aneurysm usually occurs 2-9 days after myocardial infarction and is fatal. Clinically, a rupture of the aneurysm of the heart is manifested by a sudden onset: a sharp pallor, which is quickly replaced by cyanosis of the skin, cold sweat, overflow of neck veins with blood (evidence of cardiac tamponade), loss of consciousness, cold extremities. Breathing becomes noisy, hoarse, shallow, rare. Usually death occurs instantly.
In the preoperative period, patients with cardiac aneurysm are prescribed cardiac glycosides, anticoagulants (heparin subcutaneously), antihypertensive drugs, oxygen therapy, oxygen barotherapy. Surgical treatment of acute and subacute aneurysm of the heart is indicated in connection with the rapid progression of heart failure and the risk of rupture of the aneurysmal sac. In chronic aneurysm of the heart, surgery is performed to prevent the risk of thromboembolic complications and to revascularize the myocardium.
As a palliative intervention, they resort to strengthening the walls of the aneurysm using polymeric materials. Radical operations include resection of the aneurysm of the ventricle or atrium (if necessary, followed by reconstruction of the myocardial wall with a patch), Cooley septoplasty (with aneurysm of the interventricular septum).
With a false or post-traumatic aneurysm of the heart, suturing of the heart wall is performed. If necessary, additional revascularizing intervention simultaneously perform aneurysm resection in combination with CABG. After resection and plastic surgery of the aneurysm of the heart, it is possible to develop a syndrome of small ejection, repeated myocardial infarction, arrhythmias (paroxysmal tachycardia, atrial fibrillation), inconsistency of sutures and bleeding, respiratory failure, renal failure, cerebral thromboembolism.
Aneurysm of the heart is a limited protrusion of a thinned myocardial wall, accompanied by a sharp decrease or complete disappearance of the contractility of a pathologically altered myocardial site. In cardiology, cardiac aneurysm is detected in 10-35% of patients who have had myocardial infarction; 68% of acute or chronic heart aneurysms are diagnosed in men aged 40 to 70 years.
Most often, an aneurysm of the heart is formed in the wall of the left ventricle, less often in the area of the interventricular septum or the right ventricle. The magnitude of the aneurysm of the heart ranges from 1 to 18-20 cm in diameter. Violation of myocardial contractility in the area of cardiac aneurysm includes akinesia (lack of contractile activity) and dyskinesia (bulging of the wall of the aneurysm into systole and its retraction into diastole).
What examination is necessary for suspected heart aneurysm?
Important in the diagnosis of aneurysm is a full examination of the patient. So, in the vast majority of cases, the doctor can see a pathological precardial pulsation, which is defined as the periodic protrusion of the anterior chest wall in 3-4 intercostal spaces to the left of the sternum, which coincides with the heart rate. This phenomenon is called the “rolling wave” symptom or the “rocker arm” symptom.
In addition to examination, during auscultation of the heart, you can listen to a systolic-diastolic murmur, called “squeak noise”, but it is heard in a small part of patients. In addition, when listening to the lungs, it is possible to determine single or multiple, dry or wet rales in the lower parts of the lungs with heart failure.
If the doctor suspects the formation of aneurysm of the heart, he directs the patient for examination. Of the diagnostic methods, the following are informative:
Electrocardiogram. On an ECG, an aneurysm that has reached considerable size is characterized by signs of acute myocardial damage and its necrosis. In this case, it is said that the ECG has a “frozen appearance” of acute myocardial infarction. However, the absence of signs of a heart attack on the ECG does not mean that the patient does not have aneurysm of the heart.
Classification of heart aneurysms
The classification of cardiac aneurysm is based on several criteria. By time of occurrence, there are:
- Acute aneurysm – occurs in the period not later than 2 weeks after a heart attack.
- Subacute – occurs in the period from 2 to 7 weeks after an experienced attack on the background of improper scar recovery.
- Chronic It is difficult to diagnose technically. And the symptoms resemble acute heart failure.
Depending on the manifestation, there are several types of aneurysms of the left ventricle:
- In the form of a mushroom – the bulge of a large area of tissue on a small “leg”.
- In the form of a pouch – the pathology has a rounded shape, appears on a w >
In medical practice, diffuse aneurysms have become the most common. In rare cases, mushroom-like and exfoliating are observed.
Depending on the structural features of the variety of aneurysms are:
- True – the bulge of scar tissue or dead tissue on the parietal part of the ventricle.
- False – a defect formed due to rupture of muscle heart tissue, there is a high probability of rupture of the aneurysm.
- Functional – a pathologically altered area of the active membrane of the muscle.
Aneurysm of the heart is a formation that can have different localization, wall structure, size, shape and mechanism of formation. If the disease developed as a result of a heart attack, then the timing of its occurrence is also important. Therefore, the classification of the disease is very extensive. It is carried out on the basis of ultrasound of the heart (echocardiography).
a) sharp. Formed in the initial 14 days from the appearance of myocardial cell death; the wall consists of a dead myocardium. If the protrusion is small, there is a chance that the body itself will “smooth it out” with the help of a dense scar. But if the formation is large, then it is very dangerous: from any increase in intraventricular pressure can quickly increase and even burst.
b) Subacute, occurring at 3-8 post-infarction week. The wall consists of a thickened endocardium, there are also cells of connective tissue of varying degrees of maturity. These aneurysms are more predictable, since the tissue performing them has almost formed and is more dense (less responsive to intraventricular pressure fluctuations).
c) Chronic, which form after 8 weeks after the formation of myocardial necrosis. The wall consists of three layers: the endocardium and the epicardium, between which the former muscle layer is located.
Chronic aneurysms, having, although a thinned, but rather dense wall, slowly grow and rarely burst, but other complications are typical for them:
- blood clots that form due to stagnation;
- rhythm disturbances, the reason for which is that a normal myocardium is interrupted by an aneurysm consisting of tissue that does not conduct impulses.
- True. Consist of the same walls as the heart. Intradermally may contain different amounts of connective tissue. This type we are considering.
- False. The wall of such aneurysms consists of a leaf of a heart bag or adhesions. Blood in such an artificial “bag” gets through a defect in the heart wall.
- Functional. The myocardium – the wall of such an aneurysm – is quite viable, but has low contractility. It swells only in systole.
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Most often, an aneurysm of the heart develops in the left ventricle, because its oxygen demand, like wall thickness and internal pressure, is higher. In the right ventricle, aneurysm can also develop, but its appearance in the atria is almost unrealistic.
Other possible localization of aneurysm:
- the top of the heart;
- front heart wall;
- interventricular septum. In this case, a true saccular protrusion is not formed, and the septum is shifted towards the right ventricle. This condition is life-threatening, as heart failure quickly forms here;
- rarely, the posterior heart wall.
Ultrasound of the heart indicates the size of the aneurysm. The patient’s prognosis also depends on this parameter: the greater the protrusion of the heart wall, the worse it is.
According to the form
This characteristic, determined by echocardiography, makes it possible to judge how fast the aneurysm is growing and how dangerous it is in terms of rupture.
Unlike the previous parameter, the form of the aneurysm is described in different terms:
- Diffuse. It has a small volume, its bottom is on the same level with the rest of the myocardium. Her chance to burst is small, and blood clots rarely form in her. But due to the fact that the tissue of the walls of the aneurysm is not involved in conducting the pulse and contractions, it becomes a source of arrhythmias. Diffuse aneurysm can grow and change its shape.
- Mushroom-shaped. It is formed from scars or necrosis of small diameter. It looks like an inverted jug: from the site where there are no cardiomyocytes, a small mouth leaves, which further ends with a “sac”, the cavity of which gradually expands. Such an aneurysm is dangerous rupture and thrombosis.
- Baggy. Here the wide base, the “mouth” and the cavity are not very different in diameter. Moreover, the “pouch” is more capacious than in the case of diffuse aneurysm. These formations are dangerous with a tendency to tear and accumulate blood clots.
- “Aneurysm in aneurysm.” This is the most explosive species. Here an additional aneurysm appears on the wall of the diffuse or saccular formation. This species is less common than the rest.
This classification is based on what tissue performs the protrusion wall: muscle, connective, their combination. It coincides with the separation of aneurysms in time and because of education. So, if an aneurysm formed after a heart attack, scar tissue will prevail in its wall. The expansion of the area of the heart formed as a result of myocarditis contains not only connective tissue fibers – some of the muscle cells remain intact.
The composition of the wall also affects the prognosis of the disease, and this criterion distinguishes:
- Muscle aneurysms. These defects appear when there is congenital weakness of the muscle fibers in a separate area of the myocardium, or did not stop, but the nutrition or nervous regulation in a limited area was disturbed. As a result, under the action of intraventricular pressure, the wall bends, but the scarring process does not start here. Muscular aneurysms rarely occur, for a long time they do not manifest themselves with any symptoms.
- Fibrous. These are mainly post-infarction aneurysms, where connective tissue replaces the site of dead normal myocardial cells. Such defects are weak, they gradually stretch under the influence of blood pressure. This is the most unfavorable type of aneurysm.
- Fibro-muscular. They are formed after myocarditis, ionizing radiation, toxic damage to the myocardium, sometimes after a heart attack, when the myocardium has not died out over the entire thickness of the wall.
The structure of the wall is judged by the medical history and ultrasound of the heart. A biopsy is not performed to find out the exact structure, as this will lead to the formation of a defect in the wall of the heart.
So, based on all the above classifications, cardiac aneurysms are considered the most prognostically unfavorable:
- mushroom shape;
- “Aneurysm in aneurysm”;
According to the time of occurrence, acute, subacute and chronic aneurysm of the heart are distinguished. Acute heart aneurysm is formed in the period from 1 to 2 weeks from myocardial infarction, subacute – within 3-8 weeks, chronic – over 8 weeks.
In the acute period, the wall of the aneurysm is represented by a necrotic section of the myocardium, which, under the action of intraventricular pressure, swells outwards or into the cavity of the ventricle (with localization of the aneurysm in the region of the ventricular septum).
The wall of subacute aneurysm of the heart is formed by a thickened endocardium with an accumulation of fibroblasts and histiocytes, newly formed reticular, collagen and elastic fibers; in place of the destroyed myocardial fibers, connecting elements of varying degrees of maturity are found.
Chronic aneurysm of the heart is a fibrous sac, microscopically consisting of three layers: endocardial, intramural and epicardial. In the endocardium of the wall of chronic aneurysm of the heart, there are proliferation of fibrous and hyalinized tissue. The wall of the chronic aneurysm of the heart is thinned, sometimes its thickness does not exceed 2 mm. In the cavity of a chronic aneurysm of the heart, a parietal thrombus of various sizes is often found, which can only line the inner surface of the aneurysmal sac or occupy almost its entire volume. Loose parietal thrombi are easily fragmented and are a potential source of risk of thromboembolic complications.
There are three types of heart aneurysms: muscle, fibrous and fibro-muscular. Typically, a heart aneurysm is single, although 2-3 aneurysms can be detected at the same time. Aneurysms of the heart can be true (represented by three layers), false (formed as a result of rupture of the myocardial wall and are limited by pericardial fusion) and functional (formed by the site of a viable myocardium with low contractility, swelling in the ventricular systole).
Given the depth and breadth of the lesion, a true aneurysm of the heart can be flat (diffuse), saccular, mushroom-shaped and in the form of aneurysm in the aneurysm. In a diffuse aneurysm, the contour of the external protrusion is flat, gentle, and a depression in the shape of a bowl is determined from the side of the heart cavity. Sack-shaped aneurysm of the heart has a rounded convex wall and a wide base. Mushroom aneurysm is characterized by the presence of a large protrusion with a relatively narrow neck. The term “aneurysm in aneurysm” refers to a defect consisting of several protrusions enclosed in one another: such aneurysms of the heart have sharply thinned walls and are most prone to rupture. During the examination, diffuse aneurysms of the heart are more often detected, less often – bag-shaped and more rarely – mushroom-shaped and “aneurysms in the aneurysm”.
Complications without surgery
LV aneurysms of small sizes usually do not pose a threat to the patient’s life, although in rare cases they can provoke thromboembolic complications due to the formation of parietal thrombi in the heart cavity, which are carried by blood flow to other arteries and can cause a heart attack, stroke, pulmonary or mesenteric embolism (pulmonary embolism) and mesenteric thrombosis).
- Thromboembolic complications
- Progression of chronic heart failure, the development of acute heart failure,
- Aneurysm rupture leading to rapid death of the patient.
Prevention of complications is the timely detection of aneurysm growth, regular examination by a doctor, as well as the timely detection of indications for surgical treatment.
Complications after cardiac surgery are rare and involve the development of thromboembolism, inflammatory processes in the postoperative wound, as well as the relapse of aneurysmal protrusion during immersion or plastic surgery of the aneurysm. Prevention is careful monitoring of the patient in the early (in a hospital setting), as well as in the postoperative period (in a clinic).
Aneurysm is dangerous for its thromboembolic consequences. Blood clots that accumulate in the pathological cavity can “fly off” and clog vessels of the limbs (usually the legs), the brachiocephalic trunk (this can lead to the development of a stroke), kidneys, intestines, or lungs. Therefore, aneurysm can cause:
- thrombotic embolism of the pulmonary artery – a deadly disease if large branches of this vessel become clogged;
- gangrene of the limb;
- mesenteric thrombosis (blockage of the intestinal vessels by a thrombus, which leads to its death);
- cerebral stroke;
- kidney infarction;
- recurrence of myocardial infarction.
The second dangerous complication of aneurysm is its rupture. It mainly accompanies only acute postinfarction aneurysm, developing 2-9 days after the death of a section of the heart muscle. Symptoms of aneurysm rupture:
- sharp pallor, which is replaced by blue skin;
- cold sweat;
- the veins of the neck “fill up” and pulsate;
- loss of consciousness;
- breathing becomes hoarse, shallow, noisy.
If the aneurysm was large, death occurs within a few minutes.
Arrhythmias are considered the third complication. Moreover, important organs do not receive the amount of oxygen they need.
The fourth and most common consequence of aneurysm is heart failure, usually of the left ventricular type. Signs of this complication: weakness, fear of cold, pallor, dizziness. Over time, shortness of breath, cough, swelling on the extremities appears.
The pathognomonic sign of heart aneurysm is a pathological precordial pulsation that is found on the front wall of the chest and intensifies with each heart beat.
On an ECG with a heart aneurysm, signs of transmural myocardial infarction are recorded, which, however, do not change in stages, but retain a “frozen” character for a long time. Echocardiography allows you to visualize the cavity of the aneurysm, measure its size, evaluate the configuration and diagnose thrombosis of the ventricular cavity. Using stress echocardiography and PET of the heart, myocardial viability in the zone of chronic heart aneurysm is detected.
X-ray of the chest reveals cardiomegaly, the phenomenon of stagnation in the pulmonary circulation. X-ray contrast ventriculography, MRI and MSCT of the heart are highly specific methods for the topical diagnosis of aneurysm, determining its size, and revealing thrombosis of its cavity.
According to the testimony of patients with heart aneurysm, a sounding of the heart cavities, coronarography, and EFI are performed. Aneurysm of the heart must be differentiated from a coelomic pericardial cyst, mitral heart disease, mediastinal tumors.
Aneurysm can be localized in the wall of both the atria and the right ventricle, but in connection with the anatomical and functional features of the heart, most often the formation of aneurysm occurs in the wall of the left ventricle.
According to statistics, left ventricular aneurysm develops in 5-20% of patients who have had acute myocardial infarction, and is more often diagnosed in males older than 50 years.
A qualified cardiologist can diagnose and make a prognosis of the aneurysm of the apex of the left ventricle of the heart. After examining the patient and receiving research answers, the picture will become clear. For research, ultrasound, ECG, MRI techniques are used. A timely diagnosis helps to avoid dangerous consequences, even death. To determine the treatment plan, you need to find out the location, size and structure of the aneurysm.
According to the history of the disease (heart attack, severe flu, frequent drinking of alcohol, and so on) and characteristic symptoms, a cardiologist may suspect an aneurysm. Upon examination, he will not always be able to confirm his assumption: a seal in the region of the heart above which the noise is heard can only be detected if it is large and located in the region of the apex of the heart (there it is closest to the ribs).
Suspect the presence of aneurysm indirectly by ECG. So, it should change after a heart attack, and when a defect is formed at the site of necrosis, the cardiogram “freezes”, stops changing. This study also allows you to evaluate the work of the myocardium, to establish the type of arrhythmia (this helps to choose a treatment).
The main method for detecting cardiac aneurysm is ultrasound with dopplerography. So you can not only clearly localize the aneurysm, but also measure intracardiac pressure, estimate the thickness of the heart wall, measure how much blood leaves the heart in 1 contraction, see blood clots or thinning the bottom of the aneurysmal sac, which may indicate its predisposition to rupture. Echocardioscopy also helps to distinguish true from false aneurysm, to evaluate the operation of the valves.
If it makes sense to treat the aneurysm promptly, myocardial scintigraphy is performed when a radioisotope is introduced into the blood, which accumulates selectively in the myocardial cells. Next, a special apparatus is examined, which makes it possible to obtain a clear image of the heart. And if scintigraphy is carried out with a load, then this makes it possible to calculate what load will be extremely permissible for a person.
Laboratory diagnosis in the detection of aneurysm of the heart is not informative.
Prognosis and prevention
Without surgical treatment, the course of the heart aneurysm is unfavorable: most patients with post-infarction aneurysms die within 2-3 years after the development of the disease. Relatively benign uncomplicated flat chronic heart aneurysms occur; Sack and mushroom aneurysms, often complicated by intracardiac thrombosis, have a worse prognosis. Joining heart failure is an unfavorable prognostic sign.
Prevention of heart aneurysm and its complications consists in the timely diagnosis of myocardial infarction, adequate treatment and rehabilitation of patients, the gradual expansion of the motor regime, monitoring rhythm disturbance and thrombosis.
This happens due to the thinning of muscle tissue, it no longer has the ability to contract, which means that the process of protrusion begins under high blood pressure. This pathological condition is a very serious consequence of a heart attack.
As a result, there is a violation of the functioning of the hematopoietic system. All this leads to the fact that the patient requires surgical intervention of specialists of a narrow profile.
Starting to talk about aneurysm developing in the left ventricle, experts identify several reasons.
The main among them is the rapid deterioration of muscle tissue of the “heart” organ type, others include the following:
- violation of the functioning of all wall layers of tissues, the apex of the left ventricle at the time of an attack of a heart attack;
- the fact of increased pressure in the area located inside the ventricle;
- neglect of the recommendations of specialists on the organization of physical activity in a heart attack state, that is, its excess;
- failures in the process of regeneration of muscle tissue in a post-infarction state, as a result of which a scar appears;
- mechanical injuries;
- a severe form of one or another ailment that has developed in the body due to infection in it;
- mechanical heart injury with a knife or other sharp, stabbing, cutting objects;
- receiving a closed injury (usually occurs after a fall from a high altitude, a car accident);
- bacterial endocarditis;
- syphilis infection.
All these reasons lead to the development of severe heart pathology, which must be quickly diagnosed and eliminated. Otherwise, the consequences for the body will be extremely severe.
The main forms of the course of the disease are determined by the period of its occurrence.
- acute – is formed during the first two weeks after a heart attack;
- subacute – is formed during the first month after a heart attack and is characterized by the formation of a scar having an irregular shape;
- chronic – a rather difficult form for diagnosis, it is periodically confused with acute heart failure.
And there is also a division of the aneurysm into types according to the form of its manifestations.
This division includes:
- Diffuse, in another way – flat.
Only a timely examination can give a clear idea of what kind of aneurysm specialists had to face.
In such cases, we can talk about the appointment of adequate treatment, which the patient should follow strictly.
People who have experienced an aneurysm of the left ventricle know that this pathological condition is characterized by certain symptomatic manifestations.
- cardiac arrhythmia;
- pain in the area located behind the sternum;
- shortness of breath, turning into severe asthma attacks (usually manifests itself at the time of increased physical exertion);
- the appearance of swelling of the tissues of organs;
- the occurrence of noise sounds arising in the upper part of the cardiac organ.
If these symptoms occur, some time after discharge from the hospital, when the rehabilitation process after a heart attack ends, you should immediately consult a doctor. Otherwise, there may be a threat to the life of the patient, which does not occur if you apply in the early stages of the development of the pathological condition.
Timely diagnostic procedures are the only sure way to prescribe adequate treatment in case of aneurysm. After diagnosis, the severity of the disease, as well as the duration of treatment courses, is determined. When a muscle protrudes, it is extremely important at the time of a diagnostic examination to find out three aspects related to it.
- place of localization;
- view of the structural type.
Other research methods necessary for aneurysm include:
- Conducting laboratory studies of genetic and urinary material, which allows to identify concomitant diseases that can affect the course of development of the disease.
- An x-ray of the chest area, which allows you to exclude or timely detect chest edema.
- Ventriculography of a radioisotope nature, which gives complete information not only about the location of the pathology, but also determines the residual contractility of cardiac tissues.
- Magnetic resonance imaging, which is used in cases where surgical intervention is necessary, because only this procedure allows you to determine how wide the arterial vascular passages are, as well as their exact location, magnitude and location of the disease.
- Ultrasound (ultrasound), which allows the specialist to clarify information about swollen areas and places of thinning of the heart muscles.
Considering the fact that the pathological condition is accompanied by the cessation of the normal fulfillment of the function of contraction of the heart muscles, it can lead to acute heart failure if the doctor’s recommendations are not followed. This can cause rupture of the muscle walls, which in turn will cause the patient to die instantly.
Usually, at the initial stages of treatment, it is recommended to adhere to such rules as:
- compliance with strict bed rest for a certain period;
- refusal of any physical activity;
- the use of drugs that help reduce blood pressure;
- the use of drugs that prevent the development of blood clots;
- the use of drugs antiarrhythmic action.
However, such therapy does not fully help the patient.
Usually, pathology is eliminated by surgical intervention using modern equipment. If specialists offer just such a method of treatment, it is worth agreeing, bearing in mind that aneurysm leads to rupture of heart tissue, which causes instant death.
The main preventive measure to prevent the development of the disease is the maintenance of a lifestyle that will not cause a heart attack. This involves maintaining a healthy lifestyle: be sure to adhere to a balanced diet and moderate exercise.
If some deterioration is noted, you should immediately contact a specialist. Do not start self-medication, which can result in irreparable consequences, when there will no longer be an opportunity to save the patient.
In general, the prognosis is poor, it improves only during the operation. The quality of life worsens and its duration decreases under the following factors:
- the aneurysm is large;
- its mushroom shape or “aneurysm in aneurysm”;
- it formed in the period up to 2 weeks after myocardial infarction;
- localized in the left ventricle;
- the patient’s age is older than 45 years;
- there are severe concomitant diseases: diabetes mellitus, renal pathology
The prognosis for aneurysm after a heart attack is determined based on its size and location. So, aneurysms of small size, diffusely localized on the front wall of the LV or aneurysms of the apex of the left ventricle, which do not require surgical treatment, are characterized by a favorable prognosis for the life and health of the patient.
Medium and gigantic aneurysms are often the cause of severe heart failure and thromboembolism, therefore without treatment in this case the prognosis is poor. After surgery, the prognosis improves, as in 90% of patients, quality of life increases, and five-year survival increases.
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