Giant Left Ventricular Aneurysm as a Complication in a Patient with Acute Myocardial Infarction: Case Report
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Abstract
INTRODUCTION: Giant ventricular aneurysm is a rare but highly relevant clinical entity due to its impact on cardiac function and its high morbidity and mortality. A giant ventricular aneurysm is considered when the diameter of the aneurysmal sac exceeds 5 cm. Left ventricular (LV) aneurysms are generally a consequence of mechanical complications caused by severe ischemic injury of the myocardium secondary to myocardial infarction (MI) and are associated with heart failure, arrhythmias and rupture. They are generally located apically and anteriorly, with significant mortality.
The incidence is low, and the diagnosis is usually made late through suggestive findings on chest x-ray or transthoracic echocardiogram .
CASE PRESENTATION: We present the case of an 85-year-old male who was admitted to the emergency room with severe chest pain 48 hours prior to arrival. An electrocardiogram diagnosed STEMI, with a finding of subendocardial lesion and inferior wall necrosis, angina intensity 8/10. Since there was no catheterization laboratory available, he was thrombolyzed with alteplase and presented criteria for reperfusion . A chest x-ray showed dilation in the middle and apical third of the left ventricle. An echocardiogram showed a biplane left ventricular systolic function of 28% with an image suggestive of a left ventricular aneurysm.
A chest CT scan showed a finding compatible with a giant left ventricular aneurysm measuring 65 mm x 85 mm (2.5 x 3.3 in) and the presence of a laminar thrombus.
CONCLUSION: Establishing an early diagnosis is vital to avoid complications. Treatment may be medical in patients with mild symptoms, but in those with severe heart failure or complex arrhythmias, surgery (such as surgical resection or aneurysm repair) may be necessary. A thorough evaluation and a multidisciplinary approach are recommended for the management of these patients, tailoring treatment to the individual characteristics of each case.
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