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Dr .Saeed ahmed
Dr .Saeed ahmed, Doctor
Category: Cardiology
Satisfied Customers: 4479
Experience:  MBBS/FCPS/MRCP U.K(R), Senior Registrar Cardiology
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My dad is 79 and had a heart attack in September 2008.

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My dad is 79 and had a heart attack in September 2008. Diagnosis Description was as follows: "..was presented to ..hospital following an episode of left sided chest pain radiating up to the left shoulder. ECG on presentation showed ST elevation of 2mm in anterior leads. Troponin on admission was 0.03, peaking at 11.75.
On angiography, 90% thrombotic occlusion of proximal LAD, 50% stenosis in diagonal. PCI with bare metal stent undertaken to LAD. No significant disease seen in RCA and circumflex. Mild LVF with bibasal crackles, treated with frusemide, subsequently discontinued.
ECHO showed normal LV size. Extensive anteo-septal regional wall motion bnormalities. Mild to moderate LV impairment."
My dad just has had an ultrasound yesterday and was informed that he might have Ventricular Aneurysm. Doctor asked him to come in and do another ultrasound in about 1-2 months time to make sure if he really get it.
My dad has no symptoms of heartache or whatsoever. He has been activity in activities such as swimming, jogging almost every day. The article I read telling me that Ventricular Aneurysm happend a few days after heart attach, but it has been 3 years since his first heart attack.
The assumption of Ventricular Aneurysm has made us very nervous and stressful. Would you think he really has got Ventricular Aneurysm or what is his chance of getting it? Thanks.
Hello,
Thank you for your question,
I am fellow expert in cardiology and will try to help you out.
Echocardiogram is a very sensitive test and able to pick up structural heart abnormalities with more than 90% accuracy approaching to 98%. So there are high chances that he has aneurysm if this is picked on the echocardiogram.
Here important is that his doctor does comment on what type of aneurysm it is.... A true or pseudo aneurysm(defined as aneurysm that communicates with the heart cavity through a narrow neck).
It is important because treatment is different for both cases.
Pseudo aneurysm develops with in few weeks of heart attack so with his prolong history there are more chances that this is true aneurysm.
With pseudo aneurysm he may need surgery while for true just medical treatment. In pseudo aneurysm surgery is important to prevent the chances of rupture of this area of heart.
I hope this helps.
Let me know if you have more questions.
Have a nice day.
Dr .Saeed ahmed and other Cardiology Specialists are ready to help you
Customer: replied 8 years ago.

Thanks a lot for your reply.

My dad's doctor is not 100% sure if my dad has aneurysm from the image at this stage. So he asked my dad to come in after 1-2 months time to do another echocardiogram. Could you explain why the doctor needs 1-2 months to confirm? If a pseudo aneurysm develops within a few weeks after heart attack, when a true aneurysm will develope? If my dad's case is more likely to be true aneurysm, does that mean the doctor is waiting to see if the suspected aneurysm will grow bigger? If it can grow bigger in 1-2 motnhs, how big it can grow within 6 moths or 12 months?

When you say, a true aneurysm can undertake medical treatment. Would you mean that it is treatable and the aneurysm will disppear after treatment? What will be the prognosis for both true & false aneurysm please?

Thanks a lot.

Hello,
Thank you for your reply,
In his case with long history of heart attack there are more chances of true aneurysm. These are to be followed regularly with echocardiogram to see whether they are remain static or increasing in size. These are formed due to weak walls of the heart after a heart attack. In most cases they remain same and supportive treatment options are to have a good control of blood pressure, reducing the load on the heart by using medicine like diuretics, ACEi(they help remodeling of the heart so help prevent extension of aneurysm). Plus medicine like warfarin(blood thinner) are needed once repeat echo confirms the aneurysm as clots can form in these aneurysms and can be dangerous.
I hope this helps.
Let me know if you have more questions.
Have a nice day.
Customer: replied 8 years ago.
Thanks. Would you advise what will be the prognosis for both true & false aneurysm please?
Hello,
Thank you for your reply,
Prognosis depends upon the severity of the aneurysm, which is determined by echocardiogram.
If person take good care of his blood pressure, use medicine ... diuretics, ACEi and warfarin then the progress of the aneurysm can be stopped. In most cases they remain static and do not decrease the heart function further.
Chances are 50-50 meaning it needs evaluation with echocardiogram to observe the progress.Larger the area of the aneurysm and thinner the wall.... Prognosis is worse in such cases as it is prone to rupture and may need ventriculoplasty. So if you can tell me the detailed echo report then i may be able to give some specific figures regarding prognosis.
Here is a link on this topic which tell about the prognosis, a bit lengthy but has figures based on different aneurysmal scenarios.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC487659/
I hope this helps.
Customer: replied 8 years ago.
Thanks a lot. Will ask for the echo report.
You are welcome.
Keep in touch.