Left ventricular aneurysm after myocardial infarction

Four left ventricular apical abnormalities

This editorial reviews the clinical presentation, electrocardiographic manifestations, appearance of the left ventricle by imaging techniques, and the state of the coronary arteries in four left ventricular apical abnormalities (Table I). Three of these conditions, namely, noncompaction, apical hypertrophy, and left ventricle aneurysm, can be somewhat malignant. The fourth condition--tako-tsubo--is generally benign. Treatment depends on the clinical condition of the patient.

Failure of gated SPECT and echocardiography to detect large apical aneurysm secondary to hyperdynamic left ventricular wall at the aneurysm neck

We present a patient with a history of coronary artery disease and exertional angina after an acute anterior myocardial infarction. Angiography and ventriculography revealed multivessel coronary artery disease and a large apical aneurysm. Echocardiography and gated SPECT studies were performed for further evaluation of ischemia and assessment of left ventricular function. Gated SPECT and echocardiography failed to detect a large apical aneurysm due to a hyperdynamic left ventricular wall at the neck of the aneurysm. This case demonstrates the importance of using multiple imaging modalities in the evaluation of ventricular function in the setting of coronary artery disease.