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Patient: Male, 67
Final Diagnosis: Left Ventricular aneurysm post myocardial infarction
Symptoms: Chest pain
Medication: Dual antiplatelet therapy • anticoagulation
Clinical Procedure: Cardiac catheterization
Specialty: Cardiology
Objective
Unusual clinical course
Background
Electrocardiographic presentations of left ventricle aneurysms are diver...
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Rationale:
Myocardial infarction with nonobstructive coronary artery (MINOCA) is one of the common causes of cardiac related death. While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. This report describes a case of MINOCA patient suf...
Citations
... Пациентът, който ние представяме, постъпва в Клиниката с оплаквания от лек задух и уморяемост при физически усилия, липсват характерни белези от физикалния преглед. От ЕКГ -трайната елевация на ST-сегмента варира от 84% до 100% [9] при пациенти с истинска аневризма. Cohn и сътр. ...
... съобщават за тези промени в ЕКГ при 50% (55 от 110) от пациентите [12]. Висок R-зъбец в aVR (белег на Goldberger) често се наблюдава при пациенти с ЛК аневризма [9]. Един клиничен случай, публикуван от Ola и сътр., събщава за пациент с ЛК аневризма, презентиращ се с отрицателни Т-вълни в прекордиалните отвеждания [9]. ...
... Висок R-зъбец в aVR (белег на Goldberger) често се наблюдава при пациенти с ЛК аневризма [9]. Един клиничен случай, публикуван от Ola и сътр., събщава за пациент с ЛК аневризма, презентиращ се с отрицателни Т-вълни в прекордиалните отвеждания [9]. Метаанализ, включващ 172 пациенти с псевдоаневризма, установява, че в 95% от случаите се наблюдават патологични про-hypotension. ...
Left ventricle pseudoaneurysm is a rare but serious complication, most often secondary to myocardial infarction. It is associated with high mortality due to a significant risk of rupture. We present a case of a patient with a large basal pseudoaneurysm of the lateral wall of the left ventricle. The pseudoaneurysm is discovered from a chest radiography performed after a COVID-19 infection. The diagnosis is confirmed by echocardiography and ventriculography. The patient underwent surgical treatment by endoventricular patch plasty – Dor procedure. The patient in our case lacked the typical symptoms and ECG features, furthermore he had no history of myocardial infarction, cardiac surgery, trauma or endocarditis.
... Такие изменения могут быть характерны и для больных с обширным трансмуральным ИМ. Поэтому диагноз аневризмы ЛЖ необходимо устанавливать по совокупности результатов, полученных разными методами исследования [19,20]. ...
An important place in the structure of cardiovascular morbidity is occupied by myocardial infarction (MI), especially complicated MI, including complicated by the formation of left ventricular (LV) aneurysm. The latter is a very formidable complication and leads to such life-threatening conditions as ventricular arrhythmias, heart failure, thromboembolism. The purpose of the review is to analyze the publications of foreign and Russian authors on risk factors, outcomes and treatment of patients with postinfarction LV aneurysm. Attention is paid to the role of registers in the study of this problem, as well as the analysis of literature data on the prevalence of such a complication as MI during the COVID-19 pandemic (COrona VIrus Disease 2019). It is shown that the registers of acute coronary syndrome, as a rule, do not contain separate data on patients with a formed LV aneurysm, risk factors for its development and outcomes in this group of patients. Postinfarction LV aneurysm can form only after transmural MI; therefore, it is important to keep records of patients diagnosed with transmural MI, primarily in the form of a register.
... The maximum diameter from the aneurysm to the LV septal wall was 92. 6 thrombi were seen. The EF was 48% and a dyskinetic movement in the aneurysm was evident (videos 1-3). ...
... 5 The most common electrocardiographic finding in LVA is the persistent elevation of the ST-segment. In some cases, only negative T waves in the precordial leads have been described, 6 both EKG features were absent in this patient. ...
This case report describes a patient in their late teens who presented to the outpatient department stating that they had felt the implanted cardioverter defibrillator deliver a shock 3 times within the past 6 months.
The aim: to analyze the informativeness and features of the perioperative electrocardiogram dynamics in complicated forms of coronary artery disease (CAD).
Material and methods: retrospective ECG analysis of 100 randomized high-risk patients with complicated forms of CAD who underwent surgery in the National M. Amosov Institute of Cardiovascular Surgery Affiliated to National Academy of Medical Sci- ences of Ukraine from 2009 to 2019. All the patients included in the study were classified as high-risk group for complications and mortality and had an average risk of 8.60 % (from 5.02 % to 39.38 %) according to the EuroSCORE II scale.
Results. Postinfarction left ventricular aneurysm (ALV) was localized in the anteroseptal region of the left ventricle (LV) in 94 (94 %) cases, and posterior-basal LV aneurysm (PBALV) was diagnosed in 6 (6 %) patients. Mitral insufficiency (MI) was detected in 8 (8.5 %) patients with anterior ALV and in 2 (33.3 %) cases of PBALV. Tricuspid valve insufficiency (TI) was diagnosed in 4 (4.2 %) patients with anterior ALV, and postinfarction defect of the interventricular septum (VSD) was verified in 2 (33.3 %) patients with PBALV. Diagnostics of anteroseptal ALV using ECG is highly accurate, the specificity of the method is 94 %, and the sensitivity is 95.6 %. ECG interpretation after surgery presents with certain difficulties, since nonspecific changes of the terminal part of the ventricular complex often occur that being interpreted correctly determine further treatment tactics. Positive ECG dynamics was detected in 66 (66 %) patients in the form of improved intraventricular conduction and the appearance of the R wave in leads I, avL,V2-V6,alackofdynamics –in11(11%),asarule,inpatientswithcompleteleftbundlebranchblock(LBBB),drypericarditis of II–III stage was diagnosed in 23 (23 %) patients.
Conclusions. ECG retains its importance and remains an informative and available method in modern cardiology. The cor- rect ECG interpretation before surgery helps to assess the initial severity of the condition and timely correct the therapy and management tactics in the early postoperative period.
