A 70-year-old man with a prior anterior MI 5 years ago presents for routine follow-up. ECG shows persistent ST elevation in V1–V4 and Q waves. Echocardiogram reveals an akinetic, dyskinetic region in the anterior wall with a 4.2 cm LV aneurysm. He reports no chest pain but has episodic ventricular tachycardia. Which long-term complication is this patient MOST at risk for from the aneurysm?
- A Systemic thromboembolism from mural thrombus ✓
- B Recurrent MI from plaque rupture within the aneurysm
- C Bacterial endocarditis of the aneurysmal wall
- D Aortic regurgitation from annular dilation
Correct answer: A. Systemic thromboembolism from mural thrombus
Explanation
True left ventricular aneurysms (paradoxical wall motion, persistent ST elevation, Q waves) carry a significant risk of mural thrombus formation within the dyskinetic segment due to blood stasis and activation of coagulation. Embolization of this thrombus can cause stroke, mesenteric ischemia, or peripheral arterial occlusion. These patients require anticoagulation with warfarin (INR 2–3) if a thrombus is detected on echocardiography. The aneurysm does not predispose to recurrent plaque rupture or endocarditis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.