A heart wall aneurysm (ventricular aneurysm) is the medical term for a bulge that has formed on the heart wall. Cardiac wall aneurysm occurs predominantly in the left ventricle. The heart wall aneurysm is not a classic disease; it is mainly one of the late complications after a heart attack. If the aneurysm ruptures, there is acute danger to life.
What is a heart wall aneurysm?
Heart wall aneurysms usually form in the left ventricle. The risk of developing a heart wall aneurysm is most common after a heart attack. About 20 percent of all patients who have suffered a heart attack are subsequently diagnosed with a heart wall aneurysm. Doctors distinguish between chronic and acute heart wall aneurysms. If the patient suffers a myocardial infarction, necrosis/scarring occurs subsequently, mainly in the myocardium of the heart. These necroses are stretched by the ventricular pressure, and subsequently the heart wall bulges out. Blood remains in the bulge and thickens (thrombi). The danger? The thrombi can enter the systemic circulation or the brain, causing gastrointestinal tract, kidney or brain infarcts.
Causes
Heart wall aneurysms are usually caused by ischemic heart disease. Doctors speak of ischemic heart disease when several minor or major heart attacks have already occurred and scar tissue has formed, so that the heart’s pumping capacity is already impaired. As a rule, this is a severe reduction in ejection output. The heart wall, which in places already has strong scar tissue, cannot withstand 100 percent of the pressure that is maintained in the ventricle, so that expansion occurs. A kind of bulge is formed, which causes the blood to collect and can no longer clot. If this results in blood thickening, it is referred to as thrombi. Blood clots form that migrate into the systemic circulation or brain and subsequently clog vessels.
Symptoms, complaints, and signs
Heart wall aneurysms do not cause any discomfort, especially at the beginning of their development. Patients usually do not complain of discomfort until the dilatation is so advanced that the blood vessel is already pressing on organs. Typical symptoms include difficulty swallowing, hoarseness, coughing, breathing difficulties and also circulatory problems, which occur mainly in the arms. Subsequently, cardiac arrhythmias or heart failure may be symptoms that indicate a heart wall aneurysm.
Diagnosis and disease progression
Physicians primarily detect heart wall aneurysms during follow-up examinations after heart attacks. This is because regular control examinations of the heart take place after heart attacks. The physician can therefore determine whether or not a heart wall aneurysm has formed by means of a heart ultrasound (echocardiography). If the physician is unsure or wants to confirm the diagnosis 100 percent, a magnetic resonance imaging (MRI) scan can provide the necessary results. This also provides the physician with information about the location, flow and size of the heart wall aneurysm. This information is also crucial for further therapy. If a heart wall aneurysm is present, the pumping function of the heart is impaired, resulting in reduced ejection. The physician recognizes disturbance anomalies in the area of the heart wall aneurysm, which promote the so-called thrombi. If the formed thrombi are transported into the vascular system, embolisms may occur. In extremely severe cases, there is also a possibility of rupture of the heart wall (ventricular rupture). Blood subsequently escapes from the heart, flows into the pericardium and causes cardiac compression. Such complications lead to the death of the patient in almost all cases. Other complications that can occur in the setting of a heart wall aneurysm include left ventricular failure with cardiogenic shock or cardiac arrhythmias.
Complications
Heart wall aneurysm itself arises as a complication of myocardial infarction and thus is not a classically occurring disease. As such, it can be anticipated comparatively well if appropriate screening is performed.If the onset of symptoms is very late, diagnosis is again hampered and the disease is allowed to progress to a critical point. Due to a heart wall aneurysm, the pumping capacity of the heart is impaired. The resulting weakened ejection of blood from the heart promotes the formation of thrombi, blood clots that impair blood circulation and supply to the body. If the blood vessel is completely blocked by the thrombus, an embolism occurs. This can lead to death. A second dangerous complication occurs when the heart wall aneurysm ruptures and fluid accumulates. This so-called cardiac tamponade exerts pressure on vital functions and impedes the contraction movement of the heart. The death rate is very high in such cases because the fluid can rarely be drained quickly enough by puncture and drainage. The heart wall aneurysm is often accompanied by cardiac arrhythmias and left heart failure, which also require treatment. Otherwise, these sequelae may lead to cardiogenic shock due to inadequate oxygen supply. Surgical removal is only an option if the heart wall aneurysm is appropriately located.
When should you go to the doctor?
A visit to the doctor is advisable as soon as irregularities in heart activity occur. If there are disturbances in the heart rhythm, a racing heart that cannot be explained, or persistent high blood pressure, a doctor should be consulted. If sweating, hot flashes or inner restlessness occur, the cause should be determined by a physician. Sleep disturbances, respiratory problems, a feeling of pressure in the chest, pain, and dizziness should be investigated and treated. If problems with swallowing occur and coughing or hoarseness sets in, a doctor should be consulted. If the irregularities result in a refusal to eat or drink fluids, a physician is needed. The affected person is threatened with an undersupply of the organism, which must be taken care of medically. In the case of circulatory disorders in the limbs, special care must be taken. If the affected person repeatedly suffers from cold fingers, hands or feet, a check-up is recommended. If unusual heart problems occur in situations of physical stress, this observation should be discussed with a physician. Since the heart wall aneurysm often does not show strong symptoms at the beginning of the disease, but the symptoms only become apparent in the advanced stages, a visit to the doctor should be made at the first noticeable signs. The sooner the affected person sees a doctor, the better the treatment options.
Treatment and therapy
Treatment depends primarily on the size and location of the heart wall aneurysm. In principle, heart wall aneurysms can be treated surgically and conservatively. If the physician has diagnosed a large heart wall aneurysm, it should be treated surgically – due to the risk of rupture and recurrent emboli. Finally, if it is a large heart wall aneurysm, there is a risk that it will rupture, putting the patient’s life at risk. If the physician decides to operate, there are various surgical methods available. On the one hand, he can decide to use a vascular prosthesis, on the other hand, he can insert a stent into the affected vessel. Another option is the so-called DOR-plasty. In this procedure, the heart is exposed and the heart wall aneurysm is then visualized and opened. In the course of the operation, the physician examines the areas of the heart wall that are responsible for the thinning. In the process, the physician removes the aneurysmal tissue and, if necessary, can also apply a patch to the defect that originated from the heart wall aneurysm. If the physician has diagnosed a small heart wall aneurysm that does not cause any symptoms, he or she primarily opts for conservative treatment. This mainly involves tackling risk factors, such as lipid metabolism disorders, high blood pressure, an unhealthy diet or nicotine consumption. If the patient reduces the risk factors, he or she can ensure that the heart wall aneurysm remains unchanged in size so that surgery is not required.
Outlook and prognosis
Heart wall aneurysm is a dangerous condition with a poor prognosis unless the patient is treated surgically.As with any aneurysm, there is a risk that the heart wall aneurysm has already thinned out to such an extent that a more or less large tear develops and severe internal bleeding occurs. Since the heart muscle is heavily perfused, this complication can be fatal if the affected person cannot undergo emergency surgery immediately. A prerequisite for healing is the restoration of the thinned tissue, which is why the heart wall aneurysm was able to form in the first place. If this is successful and the sutures heal without major complications after the surgical procedure, then the patient can fully recover from a heart wall aneurysm. Crucial to an accurate prognosis is still the question of how thinning of the heart wall could have occurred. If there is an underlying disease that damages the heart wall, it may not be possible to rule out the possibility that such a condition will occur again. Frequently, a heart wall aneurysm develops as a result of a heart attack and is highly susceptible to life-threatening rupture the day after. However, if the patient survives the critical first day, his or her prospects for recovery improve. With any heart wall aneurysm, there is also a risk of clot formation, which can lead to dangerous thrombosis and other complications.
Prevention
Heart wall aneurysm can be prevented only to a limited extent. Since it is predominantly a late consequence of a heart attack, it is therefore all the more important to prevent it from occurring in the first place. Lack of exercise, obesity, nicotine consumption, unhealthy diet – these are all factors that promote a heart attack (and subsequently the heart wall aneurysm).
Aftercare
In the case of a heart wall aneurysm, the further measures of aftercare usually depend very much on the time of diagnosis and on the manifestation of this disease, so that no general prediction can be made in this regard. However, early detection of the condition always has a positive effect on the further course of the disease and can also prevent further complications and discomfort. In the worst case, the heart wall aneurysm can lead to the death of the affected person, so that a doctor should be contacted at the first symptoms and signs of the disease. The treatment of the disease is usually carried out by a surgical intervention, which proceeds without any particular complications. The affected person should rest after the operation and not exert the body. Physical and sporting activities should be avoided in order not to put unnecessary strain on the body. Likewise, a healthy lifestyle with a balanced diet generally has a very positive effect on the course of the heart wall aneurysm. Fatty foods should be avoided in order to prevent high blood pressure. Even after a successful procedure, further examinations of the heart are very important. Possibly, the heart wall aneurysm results in a reduced life expectancy of the affected person.
What you can do yourself
Patients with a heart wall aneurysm always adhere to the instructions of the specialist treating them, as this is a serious condition in which serious complications are possible at any time. The options for self-help for those affected depend primarily on the type of therapy. Conservative treatment is particularly concerned with reducing known risk factors and thus avoiding surgical intervention. By reducing high blood pressure and body weight, giving up cigarette consumption and changing their diet to a healthy one, patients with heart wall aneurysms improve their well-being and quality of life. At the same time, the patient thereby reduces the likelihood that surgical treatment will be necessary for the heart wall aneurysm. In case of surgery, the patient tries to increase the success of the surgical intervention and his chances of recovery by adequate preparation. In doing so, he or she is primarily guided by the doctor’s instructions. Even before the operation, it is advisable to change to a healthy lifestyle and to avoid physical exertion and minimize psychological stress. After the operation, the patient initially remains in inpatient care and observes extended periods of rest, which serve the purpose of regeneration. The patient continues to maintain a light, heart-friendly diet at home.
