Unruptured giant left ventricular pseudoaneurysm after silent myocardial infarction

Abstract

An 88-year-old woman presented with complaints of class 2 dyspnoea for the last 6 months with episodes of paroxysmal nocturnal dyspnoea. Except for her age, she had no other risk factor for coronary artery disease. On cardiovascular examination, she had double apical impulse with a pan-systolic murmur at the apex and her ECG showed Q waves in inferior leads. She had one episode of resting typical chest pain 2 years back for which she did not seek medical consultation; afterwards, she never experienced angina pain. Transthoracic echocardiography revealed giant aneurysm involving the lateral wall of the left ventricle (figure 1, videos 1 and 2). The ratio of the maximum diameter of the orifice to the maximum internal dimensions of the aneurysmal cavity was less than 0.5 (figure 2). There was large clot in the aneurysm involving the posterior wall of the left ventricle (figures 3 and video 2). The colour flow signals across the neck of aneurysm showed bidirectional flow (figure 4) and moderate mitral …