Conservative treatment of ventricular aneurysm?

Ventricular aneurysm is a phenomenon of myocardial necrosis caused by myocardial infarction. Generally, as long as the tumor is not particularly large, it can be treated conservatively first. Most ventricular aneurysms are related to heart disease such as coronary atherosclerosis. If the tumor is relatively small, the body will not show any symptoms. If the tumor is slowly growing, it will cause left heart failure and cause embolism in the brain and kidneys.

The main methods for detecting ventricular aneurysms are:

(1) Judge based on symptoms. This complication should be considered in patients with persistent, uncontrollable left heart failure or peripheral arterial embolism, or refractory tachyarrhythmias after acute myocardial infarction.

(2) Electrocardiogram. Two weeks after acute myocardial infarction, if the ST segment continues to be elevated, ventricular aneurysm formation should be considered. However, it is currently believed that persistent ST segment elevation is a specific but not very sensitive indicator of severe left ventricular regional dysfunction.

(3) Echocardiography. It is a sensitive and reliable method for detecting ventricular aneurysm. Two-dimensional echocardiography can not only show the location of ventricular aneurysm and the size of the aneurysm cavity, but also measure the thickness and activity of various parts of the aneurysm wall. It can also evaluate the normal myocardium around the ventricular aneurysm and provide a basis for surgical removal of the aneurysm. The sensitivity, specificity and safety of echocardiography in diagnosing ventricular aneurysm are superior to surface electrocardiography, X-ray and ventriculography.

(4) Nuclides and nuclear magnetic resonance. This method has unique advantages in detecting ventricular aneurysms.

Clinical characteristics of ventricular aneurysm Due to different definition methods and diagnostic criteria, the incidence of ventricular aneurysm has been reported differently, and may account for 10% to 35% of myocardial infarction. Currently, with the development of thrombolytic therapy and early revascularization, the occurrence of ventricular aneurysm has a decreasing trend. During routine coronary angiography, ventricular aneurysms can be found in approximately 7.6% of patients. The 10-year survival rate of asymptomatic ventricular aneurysms with conservative medical treatment can reach 90%, and most patients can still remain asymptomatic, while the 5-year survival rate of symptomatic ventricular aneurysms with medical treatment is 47% to 70%. The main causes of death include arrhythmia, heart failure and recurrent myocardial infarction. Factors that affect the effectiveness of medical treatment include age, cardiac function status score, degree of coronary artery lesions, angina pectoris, previous history of myocardial infarction, mitral regurgitation, ventricular arrhythmia, size of ventricular aneurysm, residual ventricular function and left ventricular end-diastolic pressure.