SHM Converge Scientific Abstract ePoster Gallery-Incidental Left Ventricular Aneurysm

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This case describes a 78-year-old woman with no prior cardiac history who presented after falls and chronic back pain and was found to be fluid overloaded, suggesting heart failure. During evaluation, she was also noted to have a large left superior orbital mass, prompting transfer to a tertiary center. Her ECG showed Q waves in the anterior and inferior leads with T-wave inversions in anterior, inferior, and lateral leads, raising concern for a prior myocardial infarction. Echocardiography revealed a severely reduced left ventricular ejection fraction of 25% and thinning, akinesis, and aneurysmal dilation of the mid-anteroseptal, mid-inferoseptal, and apical segments, consistent with a left ventricular aneurysm.<br /><br />She was treated with diuresis and returned to euvolemia. Further cardiac workup was deferred because she required biopsy of the facial mass, which was later diagnosed as squamous cell carcinoma.<br /><br />The discussion highlights that left ventricular aneurysm is a recognized complication of transmural myocardial infarction, usually due to myocardial necrosis or later fibrous remodeling. Its incidence has declined with early revascularization. Patients often present with symptoms of cardiopulmonary disease and are typically evaluated for ischemic cardiomyopathy. Management should be individualized and may include guideline-directed medical therapy for heart failure, particularly beta-blockade and afterload reduction. Anticoagulation may be considered when thrombus, embolic events, or significant akinesis/dyskinesis are present and bleeding risk is acceptable. Surgery is generally reserved for select severe cases. Because evidence-based guidance is limited, follow-up echocardiography every 3 to 6 months is recommended.

Asset Subtitle

Tirth S. Talati

Meta Tag

Author List Andrew G. Ajemian, Brisha B. Best, Tirth S. Talati

Category Clinical Vignettes

Concept Left Ventricular Aneurysm

Concept Transmural Myocardial Infarction

Concept Electrocardiogram

Concept Echocardiography

Concept Ejection Fraction

Distinguished Non-Finalist

Presenter Organization Cooper Medical School of Rowan University and Cooper University Health Care, Camden, New Jersey

Presenting Author Tirth S. Talati

Track Adult

Keywords

left ventricular aneurysm

myocardial infarction

heart failure

echocardiography

reduced ejection fraction

akinesis

aneurysmal dilation

ischemic cardiomyopathy

beta-blockade

anticoagulation

Left Ventricular Aneurysm

Transmural Myocardial Infarction

Electrocardiogram

Echocardiography

Ejection Fraction