Left Ventricular Aneurism

Clinical History

Four days prior to admission this 81 year old man developed a cough and sore throat and about this time became acutely short of breath. This dyspnoea necessitated admission. There was no history of recent chest pain. On examination, his temperature was 38oC, blood pressure 120/80 and pulse rate 104 per minute. He was thought to have bronchopneumonia and was treated accordingly. He died several hours after admission.

Pathology

The specimen is a heart, which has been opened and mounted to display the left ventricle, left atrium, mitral and aortic valves and ascending aorta. There is hypertrophy of the left ventricular wall, which is 20 mm. thick at the mid-ventricular level (normal 15 mm). However at the apex of the heart, there is marked narrowing of the wall of the ventricle to a minimum width of 4 mm., and here the myocardium has been largely replaced by white fibrous tissue. At this site there is an aneurysmal dilatation of the ventricular wall 55 x 30 mm in diameter, which involves the interventricular septum as well as the apex. The aneurism is partly lined by mural thrombus, and elsewhere, a few yellowish atheromatous plaques are visible on its endocardial surface. A small area of fibrosis is visible on the epicardial surface of the aneurism (see back of specimen). Two coronary arteries more than 50% occluded by atheroma are visible in the atrio-ventricular groove at the right hand side of the specimen. There is mild atheroma of the ascending aorta, and patchy slight thickening of the aortic and mitral valve cusps. At necropsy, there was widespread coronary atheroma, and a recent thrombus was found in the left coronary artery. This is an example of an aneurism of the left ventricle complicating previous healed myocardial infarction.