An aneurysm of the heart (aneurysma cordis) is a limited protrusion of a thinned portion of the wall of the heart. Most often it develops as a result of myocardial infarction. Congenital, infectious, traumatic, postoperative aneurysms of the heart are much less common. Traumatic aneurysms occur due to previous closed or open injuries of the heart. This group also includes aneurysms that occur after surgery for congenital heart defects.
In the vast majority of cases, cardiac aneurysm is a complication after myocardial infarction (often transmural). Up to 25% of patients with a heart attack may be susceptible to 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 on the apex of the left ventricle, in 50-65% of cases they spread to the anterior-septal region.
Symptoms of a heart aneurysm
Clinical manifestations depend on the size and location of the aneurysm.
Acute aneurysm of the heart corresponds to the following symptoms:
• shortness of breath with episodes of cardiac asthma and pulmonary edema;
Subacute cardiac aneurysm presents with rapidly progressive symptoms of circulatory failure.
Diagnosis of a heart aneurysm
In 50% of patients, pathological precordial pulsation is detected
ECG signs are nonspecific - a "frozen" picture of acute transmural myocardial infarction is detected, there may be rhythm disturbances (ventricular extrasystole) and conduction (blockade of the left leg of the His bundle).
ECHO-KG allows you to visualize the cavity of the aneurysm, determine its size and location, and identify the presence of a parietal thrombus.
Myocardial viability in the area of chronic aneurysm of the heart is determined by stress echocardiography and PET.
X-ray contrast ventriculography, MRI and MSCT of the heart are also used to determine the size of the aneurysm of the heart, to detect thrombosis of its cavity.
For the purpose of differential diagnosis of the disease from coelomic pericardial cysts, mitral heart disease, tumors of the mediastinum, sounding of the heart cavities, coronary angiography can be prescribed.
Treatment of a heart aneurysm
It is impossible to eliminate a heart 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 of cardiac aneurysm is surgical excision and suturing of the heart wall defect. In some cases, the aneurysm wall is strengthened with the help of polymeric materials.
In the preoperative period, cardiac glycosides, anticoagulants, antihypertensives, oxygen therapy, oxygen barotherapy are prescribed. Patients are advised to strictly limit physical activity.
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