Poorly Tolerated Ventricular Tachycardia Allowing the Discovery of a Post-infarction Aneurysm: Clinical Case
Published: 2022-12-03
Page: 337-341
Issue: 2022 - Volume 5 [Issue 1]
F. Karim *
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
I. Tlohi
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
N. Mahoungou-Mackonia
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
Y. Hamine
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
H. Seydou
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
M. Njie
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
C. B. Mahamadou
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
M. Haboub
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
S. Arous
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
G. Benouna
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
A. Drighil
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
L. Azouzi
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
R. Habbal
Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Left ventricular pseudoaneurysms are rare. They are usually form from a rupture of the myocardium contained by pericardial adhesions. Unlike true aneurysms, false aneurysms have a narrow neck and lack myocardial elements. They can be constituted spontaneously or acquired.
We report the case of a 60-year-old patient, an active alcoholic and tobacco user, consulted for palpitations evolving for 5 hours associated with NYHA stage II dyspnea. In whom the initial examination found a hemodynamically unstable patient with a BP of 97/65 mmHg, tachycardia at 160 bpm, a systolic murmur along the left edge of the sternum radiating towards the its tip and base, with crackles at the bases of the lungs. On the ECG, we note a ventricular tachycardia reduced by an external electric shock of 200 joules. The post-reduction ECG showed a regular sinus rhythm with Q waves of infero-basal necrosis. Transthoracic ultrasound revealed a non-symmetrical dilated left ventricle with hypokinesia localized at the inferior, infero-septal and infero-lateral walls with an aneurysm developed at the expense of its infero-basal wall, 30% EF associated with mild mitral regurgitation. Objective biological evaluation of cardiac enzymes was slightly elevated, the rest of the evaluation was without abnormality. The coronarography shows a tight stenosis of the middle and distal circumflex artery, revascularized by the placement of 2 active stents. The patient was put on dual antiplatelet, beta-blocker and ACE inhibitor therapy in addition to amiodarone to maintain sinus rhythm.
Left ventricular aneurysm is a classic complication after myocardial infarction, potentially causing congestive heart failure, thromboembolic event due to parietal rupture, or sometimes ventricular arrhythmia.
Keywords: Ventricular tachycardia, myocardial infarction, aneurysm
How to Cite
Downloads
References
Martínez MÁ, Pavón M, Hidalgo R. Left ventricular aneurysm and late ventricular arrhythmia after myocardial contusion. Rev Esp Cardiol Engl Ed. 2003;56:745‑6.
Haine SE, Paelinck BP, Vrints CJ. Post-traumatic focal true left ventricular aneurysm. Heart. 2004;90:1009‑1009.
Guo JR, Zheng LH, Wu LM, Ding LG, Yao Y. Aneurysm-related ischemic ventricular tachycardia: safety and efficacy of catheter ablation. Medicine (Baltimore). 2017;96: e6442.
Cardiac Aneurysm with Ventricular Tachycardia and Subsequent Excision of Aneurysm | Circulation [Internet].
[Cité 27 Oct., 2022].
Available:https://www.ahajournals.org/doi/10.1161/01.CIR.20.2.251
Singh S, Puri A, Narain V, Sahni J. Post-traumatic left ventricular pseudoaneurysm. Interact Cardiovasc Thorac Surg. 2012;14: 359‑61.
Keskin M, Çınar T, Hayıroğlu Mİ, Kozan Ö. Resistant ventricular tachycardia due to idiopathic left ventricular aneurysm: Successful treatment with surgery. J Tehran Heart Cent. 2019;14:33‑6.
Hage F, Hage A, Al-Amodi H, Goela A, Guo LR. Surgical management of patient with left ventricular aneurysm and ventricular tachycardia. SAGE Open Med Case Rep. 2021;9:2050313X211065881.
Sattar Y, Alraies MC. Ventricular Aneurysm [Internet]. Stat Pearls [Internet]. StatPearls Publishing; 2021.
[Cité 27 Oct., 2022].
Available:https://www.ncbi.nlm.nih.gov/books/NBK555955/
Zhang X, Liu X. Ventricular tachycardia and heart failure in a patient of mid‑ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: A case report. Exp Ther Med. 2019;18: 2238‑42.
Masson E. Ventricular tachycardia revealing a left ventricular aneurysm [Internet]. EM-Consulte.
[Cité 27 Oct., 2022].
Available:https://www.em-consulte.com/article/232901/ventricular-tachycardia-revealing-a-left-ventricule