Left ventricular aneurysm on X-ray chest PA view
Left ventricular aneurysm on X-ray chest PA view, seen as a bulge along the left heart border just above the apex. Clinical examination in this case will show a dyskinetic pulsation above the apex beat which will cause a see-saw movement out of phase with the apex. The bulging out in systole can also be documented by fluroscopy, echocardiography and left ventricular angiography. A true aneurysm has all the three layers (pericardium, myocardium and endocardium) in its wall and has a wide neck, while a pseudoaneurysm is bounded only by the pericardium and has a relatively narrrower neck. A true aneurysm of the left ventricle seldom ruptures while a pseudo aneurysm of the left ventricle has a high chance for secondary rupture (the primary rupture being the one which caused the pseudo aneurysm). The ECG in true aneurysm may show persistent ST segment elevation. Since the aneurysm wastes a part of the systolic ejection effort of the ventricle, it can cause refractory heart failure. Ventricular arrhythmias are also likely due to re-entrant circuits in the border zone of viable myocardium surrounding the aneurysm.