Four weeks after a large anterior STEMI, a 61-year-old man presents with dyspnea and near syncope. Echocardiography reveals a thin-walled outpouching at the cardiac apex containing turbulent flow, connected to the left ventricular cavity through a narrow neck. Which complication of myocardial infarction has occurred?
- A True left ventricular aneurysm
- B Ventricular septal rupture
- C Left ventricular pseudoaneurysm ✓
- D Papillary muscle rupture
Correct answer: C. Left ventricular pseudoaneurysm
Explanation
A pseudoaneurysm is a contained free wall rupture: the hematoma is sealed by adherent pericardium and communicates with the ventricle through a narrow neck. It can enlarge progressively and rupture freely, so surgical repair is indicated even if the patient is stable. A true aneurysm has a wide neck, consists of scarred myocardium with dyskinetic bulging, and is managed medically unless there is refractory heart failure or arrhythmia. Septal and papillary muscle ruptures produce shunts or regurgitation rather than a narrow-necked cavity.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.