Heart wall aneurysm, cardiac aneurysm
A ventricular aneurysm is also known as a heart wall aneurysm or cardiac aneurysm. It is a pathological protrusion of the heart wall.
The heart muscle is replaced by scar tissue, which may lead to reduced heart function. Blood clots can form in this bulge. There is a risk that they could drift with the bloodstream to other organs and trigger an embolism there. If a ventricular aneurysm is not treated medically, serious heart damage is often the result. In the worst case, the heart wall can rupture at the overstretched site of the aneurysm. This means acute danger to life.
A ventricular aneurysm (heart wall aneurysm) is almost always preceded by a heart attack. The infarction has originally scarred healthy tissue of the heart wall. As a result, the scar tissue, which is barely elastic, can no longer optimally follow the constant movements of the heart. It cannot adequately withstand the pressure in the heart. The heart wall expands and becomes thinner. After some time, a bulge (an aneurysm) forms in one of these thinned-out areas.
A ventricular aneurysm almost always occurs in the left chamber of the heart (in the left ventricle). It pumps oxygen-rich blood into the body and has to exert more pumping force than the right ventricle. The pressure generated in the left ventricle is therefore greater.
A ventricular aneurysm is either sac-shaped (saccular) or spindle-shaped (fusiform). There are also mixed forms. If such a bulging area of the heart wall tears, experts speak of a ventricular rupture. It often leads to blood leaking out and filling the pericardium. It surrounds the heart wall. A ventricular rupture means acute danger to life.
With smaller aneurysms, it is more common for the ventricular aneurysm to only bulge without rupturing. This is not without danger either: blood clots can form in the bulges. If they become detached and enter other organs via the bloodstream, they can become lodged there and trigger a heart attack.
There are not many diseases for which there are so many different names. Here are some of the frequently used ones:
The myocardium is the heart muscle. It is surrounded by a thin inner skin and a thin outer skin. All three layers (inner skin, muscle, outer skin) form the heart wall. It encloses the heart chambers (heart cavities). There are four of these: a left and right atrium and a left and right main chamber (ventricle or actual heart chambers).
The word ventricle initially only means cavity (Latin: ventriculus = small belly). However, when this term is used in connection with the heart, it refers to the right or left ventricle.
In around 20 percent of all patients who have suffered a heart attack, a ventricular aneurysm occurs as a result. In Switzerland, around 15,000 men and women who have suffered an acute heart attack are treated in hospital every year. It is estimated that around 3000 of these patients suffer from a heart wall aneurysm.
More men than women have heart attacks. The number of male patients suffering from ventricular aneurysms is therefore higher than the number of female patients.
Since heart attacks occur more frequently in old age than in younger years, this also applies to cases of heart wall aneurysms. However, men are on average younger than women when they suffer a heart attack. This probably also applies to a ventricular aneurysm.
Aneurysms usually occur in places where a vessel wall is weakened. Only rarely is the cause of a ventricular aneurysm a congenital weakness of the connective tissue. A second, equally rare cause of a heart wall aneurysm is Chagas’ disease. This is an infectious disease caused by the bite of predatory bugs. It is mainly found in Central and South America.
In the vast majority of cases, heart wall aneurysms occur as a result of a heart attack. An aneurysm is often preceded by several smaller infarcts. During a heart attack, cells of the heart muscle (the myocardium) die. This happens when parts of the muscle do not receive enough oxygen-rich blood. This is usually caused by a blood clot. It narrows or blocks an artery that supplies the heart muscle with blood.
The heart muscle forms the thickest and central part of the heart wall. If the tissue here dies and scars after a heart attack due to a lack of oxygen, it is subsequently thinner and weakened. If the weak point can no longer withstand the pressure of the blood, it expands under the tension and bulges. This bulge, the myocardial aneurysm or heart wall aneurysm, usually forms at the tip of the heart.
As mentioned above, the cause of a ventricular aneurysm is usually a heart attack caused by changes in the coronary arteries with cholesterol and plaque formation in the wall (so-called coronary heart disease). Therefore, the risk factors that lead to an aneurysm are the same risk factors that promote coronary heart disease. In other words: If you manage to avoid a heart attack by taking appropriate preventive measures, then you are also very likely to avoid getting a heart wall aneurysm.
If you have developed a heart wall aneurysm (ventricular aneurysm), you will probably not feel any symptoms at first. The first symptoms usually only appear at an advanced stage of the aneurysm:
If you feel an accelerated heartbeat without physical exertion and have had a heart attack in the past, you must consult a doctor.
If we suspect that you may have developed a heart wall aneurysm, we will first ask you whether you have had a heart attack. We will then examine you. There are various methods available for this, which are hardly or not at all physically stressful for you.
Since a ventricular aneurysm usually does not cause any symptoms in the early stages of its development, early detection is hardly possible. An aneurysm of the heart wall is often only noticed when the patient comes in for a medical check-up after a heart attack. The myocardial aneurysm then shows up during an ultrasound examination, for example.
It is possible to avoid an aneurysm of the heart by taking preventive measures. The best way: try to avoid a heart attack by adopting a healthy lifestyle. You should pay particular attention to the following risk factors and actively counteract them:
In the course of a ventricular aneurysm, serious damage can occur in your body if the aneurysm is not treated.
Such dramatic consequences occur mainly with larger ventricular aneurysms. Smaller aneurysms, on the other hand, can remain in a stable condition for a longer period of time. However, it must be supported with suitable therapy so as not to jeopardize stability.
How we proceed with the treatment of the heart wall aneurysm depends primarily on how large the aneurysm is.
A ventricular aneurysm is usually treated conservatively with medication to reduce the risk of enlargement of the aneurysm and the risk of tachycardia or blood clots. Drug treatment of heart failure is important to reduce its progression. Additional treatments such as the implantation of a cardiac defibrillator may also be recommended to reduce the risk of fatal heart rhythms. A recurrent tachycardia may sometimes require an electrophysiology procedure to treat the scar that is causing the tachycardia.
In rare cases, surgical treatment of the ventricular aneurysm is necessary. The aneurysm is cut out of the heart wall and the original shape of the heart is restored. In very severe cases, a heart transplant may be considered.