Aneurysm of the heart (aneurysma cordis) is a limited protrusion of a thinned section of the heart wall. Most often it develops as a result of myocardial infarction. Congenital, infectious, traumatic, postoperative heart aneurysms are much less common. Traumatic aneurysms occur due to closed or open heart trauma. This group also includes aneurysms that occur after surgery for congenital heart defects.
In the overwhelming majority of cases, cardiac aneurysm is a complication after a myocardial infarction (usually transmural). Up to 25% of patients with a heart attack can be affected by this disease.
According to the time of occurrence, aneurysms are divided into acute (1-2 weeks from the onset of myocardial infarction), subacute (3-6 weeks) and chronic. Most often, postinfarction aneurysms are localized on the anterolateral wall and at the apex of the left ventricle, in 50-65% of cases they spread to the antero-septal region.
Heart aneurysm symptoms
Clinical manifestations depend on the size and location of the aneurysm.
The following symptoms correspond to an acute aneurysm of the heart:
• shortness of breath with episodes of cardiac asthma and pulmonary edema;
• prolonged fever;
• increased sweating;
• cardiac arrhythmias (bradycardia, tachycardia, extrasystole, atrial and ventricular fibrillation, blockade).
Subacute cardiac aneurysm is manifested by rapidly progressive symptoms of circulatory failure.
Diagnostics of the heart aneurysm
Pathological precordial pulsation is detected in 50% of patients
ECG signs are nonspecific - a "frozen" picture of acute transmural myocardial infarction is revealed, rhythm disturbances (ventricular extrasystole) and conduction (left bundle branch block) may be present.
ECHO-KG allows visualizing the aneurysm cavity, determining its size and localization, and detecting the presence of a parietal thrombus.
Myocardial viability in the area of chronic heart aneurysm is determined by stress echocardiography and PET.
With the help of chest x-ray, it is possible to identify cardiomegaly, stagnant processes in the blood circulation.
Radiopaque ventriculography, MRI and MSCT of the heart are also used to determine the size of the heart aneurysm, to detect thrombosis of its cavity.
For the purpose of differential diagnosis of the disease from the coelomic pericardial cyst, mitral heart disease, mediastinal tumors, probing of the heart cavities, coronary angiography can be prescribed.
Heart aneurysm treatment
It is impossible to eliminate cardiac aneurysm with conservative methods of treatment, and when the first signs of heart failure appear, the question of surgery is raised. The main method of treatment for heart aneurysms is surgical excision and suturing of the defect in the heart wall. In some cases, the aneurysm wall is strengthened using polymeric materials.
In the preoperative period, cardiac glycosides, anticoagulants, antihypertensive drugs, oxygen therapy, oxygen barotherapy are prescribed. Patients are advised to strictly restrict physical activity.
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