Poorly Tolerated Ventricular Tachycardia Allowing the Discovery of a Post-infarction Aneurysm: Clinical Case

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.