Ventricular Aneurysm

What is a ventricular aneurysm?

A ventricular aneurysm is a bulge or weakened area in the wall of your heart’s ventricles (lower pumping chambers). It most commonly occurs in the left ventricle after a heart attack causes heart muscle to die or weaken.

When the heart pumps blood, the weakened area bulges like a balloon. A ventricular aneurysm can rupture (burst). A ruptured aneurysm is a life-threatening emergency that requires immediate medical care.

What are the types of ventricular aneurysms?

There are different types of ventricular aneurysms. A ventricular aneurysm may be a:

• True ventricular aneurysm: Damage to the heart wall (usually from a heart attack) weakens a section of the ventricle. A blood-filled sac may form in the weakened area.
• False ventricular aneurysm (pseudoaneurysm): Damage to the ventricular wall allows blood to collect in the pericardium. This membrane surrounds the heart.

How common are ventricular aneurysms?

About 5% to 7% of people who experience a heart attack (myocardial infarction) develop a ventricular aneurysm. Approximately 1.5 million Americans have heart attacks every year.

Ventricular aneurysms are more common if a heart attack affects the entire thickness of the heart muscle (myocardium).

What causes ventricular aneurysms?

Heart attacks are the top cause of ventricular aneurysms. This cardiac event causes heart muscle to die. Scar tissue forms on the damaged area. Over time, this scar tissue can stretch and become thinner, causing a weakened section of heart muscle.

Rarely, a ventricular aneurysm is present at birth. This is a congenital heart condition or birth defect. The aneurysm may go undetected until it causes problems during adulthood.

Less common causes of ventricular aneurysms include:

• Endocarditis.
• Overuse of steroids or nonsteroidal anti-inflammatory drugs (NSAIDs).
• Rheumatic fever.
• Sarcoidosis.
• Complication of open heart surgery.
• Syphilis.
• Traumatic accidents.
• Tuberculosis.
• Chagas disease (a parasitic infection that isn’t common in the United States).
• Apical hypertrophic cardiomyopathy.

Who is at risk for a left ventricular aneurysm?

Ventricular aneurysms are more likely to occur in people who:

• Are women older than 65.
• Have a family history of heart (cardiovascular) disease, coronary artery disease or heart attacks.
• Have an enlarged heart (hypertrophic cardiomyopathy).

What are the symptoms of a left ventricular aneurysm?

Left ventricular aneurysms may not cause symptoms, especially if the weakened area is small. Some people experience symptoms like:

• Angina (chest pain or pressure).
• Edema (fluid retention).
• Fatigue.
• Heart palpitations.
• Shortness of breath.
• Stroke (due to a blood clot which may form in the aneurysm).

What are the complications of ventricular aneurysms?

A ruptured aneurysm is the biggest concern. In rare instances, a person may experience cardiogenic shock. This is a life-threatening condition in which the heart cannot pump enough blood to meet the body’s needs. It’s a medical emergency.

Ventricular aneurysms weaken the left ventricle, making it harder for your heart to pump blood to the body. Heart failure can occur.

Ventricular aneurysms also increase your risk of:

• Blood clots and strokes.
• Myocardial ischemia.
• Ventricular tachycardia (fast and dangerous abnormal heart rhythm).

How are ventricular aneurysms diagnosed?

Ventricular aneurysms don’t always cause symptoms. If you’ve had a heart attack or have other risk factors, your healthcare provider may order tests to check for this condition. Ventricular aneurysms typically develop within three months of a heart attack.

Imaging tests to detect aneurysms include:

• Chest X-rays.
• Angiogram, including coronary computed tomography angiogram (CCTA).
• CT scan.
• Echocardiogram.
• Electrocardiogram (ECG).
• MRI.

How are ventricular aneurysms treated?

Ventricular aneurysms that don’t cause symptoms may not need surgical treatment. Your healthcare provider will order regular imaging tests. These tests monitor the aneurysm for signs of change.

Many people benefit from cardiac rehabilitation after a heart attack. Specialists can help you make lifestyle adjustments to improve heart health and lower the risk of future heart events.

These medications can also lower the risk of complications:

• Aspirin or medications to prevent blood clots (anticoagulants).
• Blood pressure medicine.
• Cholesterol-lowering drugs like statins.
• Heart failure and heart arrhythmia

What is true left ventricular aneurysm surgery?

True ventricular aneurysms that cause problems like chest pain or heart failure may need surgical treatment. Heart surgeons perform an open-heart surgery procedure called ventricular reconstructive surgery or ventricular remodeling.

During this procedure, a surgeon:

• Removes the weakened section of heart muscle (aneurysm).
• Sews the healthy areas of the heart together or places a synthetic patch on the weakened area to strengthen it.

If you develop an arrhythmia, you may need surgery to place a device that regulates heart rhythm. These devices include implantable cardioverter defibrillators (ICD) and pacemakers.

What is false left ventricular aneurysm (pseudoaneurysm) surgery?

Untreated false ventricular aneurysms (pseudoaneurysms) claim the lives of half of the people who develop them. Your healthcare provider may recommend open heart surgery to repair the pseudoaneurysm.

Can you prevent ventricular aneurysms?

These steps may prevent a ventricular aneurysm. They can help you lower your risk of heart disease or a heart attack:

• Eat a heart-healthy diet that’s low in sodium.
• Exercise regularly.
• Find healthy ways to manage stress.
• Limit alcohol consumption.
• Lose weight (if needed) and maintain a healthy weight.
• Manage conditions that strain the heart like high blood pressure, diabetes and high cholesterol.
• Seek help to quit smoking, and avoid secondhand smoke.

What is the outlook for people with ventricular aneurysms?

About 9 in 10 people with nonproblematic ventricular aneurysms are alive five years after the initial diagnosis. When ventricular aneurysms cause untreatable symptoms, the risk of life-threatening problems goes up.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Severe chest pain.
• Shortness of breath.
• Signs of a heart attack.
• Sudden racing or irregular heartbeat.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the ventricular aneurysm?
• What type of ventricular aneurysm do I have?
• How big is the aneurysm?
• How can I reduce my risk of an aneurysm rupture?
• What medications should I take?
• What are the medication’s side effects?
• Do I need surgery?
• What are the risks of aneurysm repair surgery?
• Should I look out for signs of complications?

A note from Cleveland Clinic

A ventricular aneurysm is a weak area in a heart ventricle (lower pumping chamber). Left ventricular aneurysms are the most common. They typically affect people who have had heart attacks. Most aneurysms don’t cause symptoms. When symptoms occur, you may need medications or surgery. A ruptured ventricular aneurysm can be life-threatening. Call 911 if you experience severe chest pain, difficulty breathing or other signs of a heart attack.