What Is Ventricular Aneurysm?

Introduction

The heart is one of the most important organs in the body. Beating around the clock to ensure that blood circulates around the body. Although the heart is a marvellous organ, conditions that cause defects or damage to it can be very dangerous.

Ventricular Aneurysm is one of these conditions and involves part of the heart muscle forming scar tissue, which causes the heart to bulge outwards.¹ Ventricular Aneurysm is a serious condition that can cause stroke or death if not treated.

Anatomy of the heart

The heart is an organ mainly made up of a muscle called cardiac muscle. It is split into four chambers, the smaller atria on top and the larger ventricles below, all encased in a fibrous sac called the pericardium. The right atrium receives blood from the rest of the body before emptying into the right ventricle below. The thicker muscle of the ventricle allows it to pump blood to the lungs for oxygenation. 

Once oxygenated, the blood travels back to the heart and enters the left atrium. From there, the blood is emptied into the left ventricle, where it can be pumped around the rest of the body, carrying oxygen to cells throughout the body.²

Ventricular aneurysm basics

Blood vessels are designed to expand and contract with the pumping of blood; however, weaknesses in the walls of blood vessels can cause them to bulge out beyond the point they should be able to. The bulges caused by the weakened blood vessel walls are called aneurysms.³

The thick walls of the heart ventricles can cause aneurysms called a ventricular aneurysm. Damage to the heart can cause scar (fibrous) tissue to form that stops it from being able to contract during a heartbeat. This can develop into a Ventricular Aneurysm, which can be divided into two types:

• True Ventricular Aneurysms: Pressure from blood against the scar tissue within the ventricle wall prevents the ventricle from contracting. Over time, the ventricle wall begins to thin and bulge outwards, creating a cavity within the ventricle. The majority of true ventricular aneurysms are of the left ventricle due to having a thicker wall compared to the right.¹
• False Ventricular Aneurysms (Pseudoaneurysms): A much rarer form of ventricular aneurysm. Death of ventricle wall tissue can cause the wall to rupture. Through this rupture, blood can leak from the ventricle, with the surrounding sac holding the blood in. This creates a swell that looks like the bulge of an aneurysm but without the bulging cavity within the ventricle.⁴

Causes and risk factors

The causes and risk factors of Ventricular Aneurysms can be split into two categories:

Congenital: Caused by genetics, ventricular aneurysms may be present from birth.⁵

Acquired: Ventricular aneurysm can develop due to a number of causes; these can be broken down into:

• Myocardial Infarction (Heart attack) is the most common cause of ventricular aneurysm and involves a blockage in the heart preventing oxygenated blood from reaching the ventricle. Tissue within the ventricle wall starts to die (infarction), which leads to scar tissue forming, starting the process of aneurysm formation or a rupture.
• Trauma is caused by injuries to the chest, such as those caused by a car accident. These injuries can cause both true and false ventricular aneurysms.^6,7
• Infections can damage the muscle of the ventricle wall, including infective endocarditis, tuberculosis, syphilis, Chagas disease and rheumatic fever.¹

Symptoms and clinical presentation

Ventricular aneurysms can be present without any symptoms, such as those with congenital causes commonly not found until adulthood. Heart attack is the main cause of ventricular aneurysm. Symptoms include:⁸

• Chest Pain
• Shortness of Breath
• Tiredness
• Irregular Heartbeat

After a heart attack, the ventricles will start to change within 2-4 weeks to resemble an aneurysm. Symptoms that a ventricular aneurysm may have developed are:¹

• Fast heart rate (Tachycardia)
• Irregular heart rate (Arrhythmia)
• Swelling of the ankles and feet (pedal oedema)
• Crackling noise when breathing in or out (Basal lung crepitations)

Diagnosis of ventricular aneurysm

For people who have had a heart attack or have symptoms of one, tests will be done. These include:⁴

• Echocardiography
• Electrocardiogram (ECG)
• Cardiac Magnetic Resonance Imaging (MRI)
• Angiogram
• Computerised Tomography (CT)

These tests look at both images of the heart and its activity to spot any irregularities. If there are any, these tests can find out exactly what they are and if they are caused by ventricular aneurysms.

Blood tests can also be done to find out if the heart has become damaged by finding specific proteins in the blood. Blood tests alone can’t diagnose ventricular aneurysms, but they can help point doctors in the right direction in diagnosis.⁹

Complications and risks

Having a ventricular aneurysm can lead to other conditions that can be life-threatening if not treated. These include:

Heart failure

Ventricular aneurysm causes the heart not to operate at full capacity. This means that the heart isn’t outputting the amount of blood that it should be, causing the rest of the body to not receive the oxygen it needs.¹⁰

Thrombus formation and stroke 

Blood within the aneurysm cavity may not be able to leave the ventricle when it contracts. The blood sitting within the cavity can clot, forming a thrombus. This thrombus can be dangerous as it can break free and block narrower blood vessels, like those in the brain. This causes a stroke as the brain tissue further along the blocked blood vessel can't get the oxygen it needs.¹¹ 

Ventricular arrhythmias 

During a heartbeat, the muscles of the heart contract, first with the atria, then by the ventricles. This is controlled by an electrical signal that travels through the walls of the heart. The changes to the walls of the ventricles can disrupt the electrical signal, leading to uncoordinated contraction.¹²

Rupture of aneurysm

Ventricular aneurysms can rupture, causing massive internal bleeding, which is extremely dangerous and needs immediate medical attention. The chances of ruptures are lower once the ventricular aneurysm gets to a certain age due to the scar tissue providing support.¹

Treatment options

Treatment of Ventricular aneurysm can be broken down into three areas:

Medication

Medications used to treat ventricular aneurysms focus on lowering blood pressure and stopping blood clots from forming. Medications that lower blood pressure help reduce the amount of bulging that happens to the ventricle wall. These include ACE inhibitors, diuretics, beta-blockers and calcium channel blockers.¹³

Anticoagulants help prevent blood clots from forming in the heart, which can cause strokes. These include medications such as warfarin, heparin and rivaroxaban.¹⁴

Surgery

There are three main types of surgery to treat ventricular aneurysm.

Aneurysm Resection: Involves cutting out the damaged part of the ventricle wall before stitching the healthy parts back together.¹⁵

Coronary Artery Bypass Grafting (CABG): This improves blood flow to areas of the heart that aren’t getting enough blood due to a blockage or narrowing of a blood vessel. It involves taking a blood vessel from elsewhere in the body to create a new one within the heart, allowing for a new route for blood to reach certain areas of the heart.¹⁶

Heart Transplant: Completely replaces the heart with a healthy one.¹⁵

Cardiac rehabilitation

A programme to help tackle underlying factors involved in the development of ventricular aneurysms so that the condition doesn’t worsen. The programme will also help with any mental effects of the condition as well as helping with any of its symptoms.¹⁷

Prognosis and outlook

Survival rates are affected by the size of the aneurysm and if surgery is performed. The smaller the aneurysm, the better the life expectancy. With surgery, the 5-year survival rate is between 70-80% compared with 68% for those who don’t have surgery.¹

The biggest cause of death in people with ventricular aneurysm is heart attack, so it is very important to reduce the chances of another happening. An effective way of doing this is through lifestyle changes.

Lifestyle changes

By working with the cardiac rehabilitation team, the chances of complications caused by ventricular aneurysms can be reduced, allowing for a longer and better quality of life. These lifestyle changes can include:

• Losing weight
• Reducing stress 
• Lowering blood pressure
• Quitting smoking 
• Reducing fat and salt in the diet.¹⁷

Follow-up appointments should be attended as these check for any changes to the heart, which could detect issues before they cause any more damage.

Prevention

The main way to prevent a ventricular aneurysm is through a healthy lifestyle. This includes:¹⁸

• A healthy diet
• Regular exercise
• Lowering stress 
• No smoking

Making these changes can help combat underlying conditions that have a big role in causing heart attacks that result in ventricular aneurysms. These include high blood pressure, obesity, diabetes and coronary artery disease.¹⁸

It is vital you contact your doctor if you might be at risk of a heart attack or ventricular aneurysm. Your doctor can then refer you to have tests and, if needed, arrange treatment to lower any risks.

Conclusion

To summarise, ventricular aneurysms are bulges in the ventricles of the heart. The majority of ventricular aneurysms are caused by heart attacks but can also be caused by injuries, infections or genetics. Most of the time, they don’t have any symptoms, so it is important to know the symptoms of a heart attack and make sure that you attend follow-up appointments if you have had a heart attack. Ventricular aneurysms are diagnosed by scans of the heart and its activity.

Ventricular aneurysms are treated through medication to lower blood pressure and stop blood clots from forming, as well as surgery to try and repair damaged areas of the heart. They have potentially fatal complications such as heart failure, blood clots and strokes. It is vital to follow treatment as well as make healthy lifestyle changes to reduce the risk of these happening.