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Post-MI LV Aneurysm — EECC MCQ

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ModerateCoronary Artery DiseasePost-MI LV AneurysmEECC

A 60-year-old man with a previous anterior MI has a chronic LV apical aneurysm on echocardiography. The aneurysm wall is thin, akinetic, and calcified. LVEF is 35%. He has no symptoms of HF. What are the potential complications of this LV aneurysm?

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Correct answer: E — Mural thrombus formation (with risk of systemic embolisation), ventricular arrhythmias (re-entrant VT from the scar border zone), and progressive HF from adverse LV remodelling

A true LV aneurysm (a discrete, thin-walled akinetic/dyskinetic segment containing myocardial scar) is a recognised complication of transmural MI. Complications include: (1) mural thrombus — stasis within the aneurysm promotes thrombus formation with risk of systemic embolisation (stroke, peripheral); anticoagulation is indicated when thrombus is present; (2) ventricular arrhythmias — the scar border zone (interface between viable myocardium and scar) is a substrate for re-entrant VT; (3) progressive HF — the aneurysm expands with each cardiac cycle (paradoxical systolic expansion), wasting cardiac energy and promoting adverse remodelling; (4) rarely, rupture (pseudoaneurysm rather than true aneurysm). Surgical aneurysmectomy (Dor procedure) may be considered in selected cases.

Reference: ESC (2023): ACS Guidelines; ESC (2022): VA/SCD Guidelines