心室瘤
WordNet
- of or relating to a ventricle (of the heart or brain)
- a cardiovascular disease characterized by a saclike widening of an artery resulting from weakening of the artery wall (同)aneurism
PrepTutorEJDIC
- 動脈瘤(りゅう)
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/29 18:15:31」(JST)
[Wiki en表示]
Left ventricular aneurysm
An ECG of a person with a left ventricular aneurysm. Note the ST elevation in the anterior leads.
Ventricular aneurysms are one of the many complications that may occur after a heart attack (myocardial infarction). They usually arise from a patch of weakened tissue in a ventricular wall, which swells into a bubble filled with blood. This, in turn, may block the passageways leading out of the heart, leading to severely constricted blood flow to the body. Ventricular aneurysms can be fatal. They are usually non-rupturing because they are lined by scar tissue.
Left ventricular aneurysm can be associated with ST elevation.[1]
Contents
- 1 Causes
- 2 Signs and symptoms
- 3 Investigations
- 4 Treatment
- 5 References
Causes
Ventricular aneurysms are usually aftereffects of myocardial infarctions. When the heart muscle (cardiac muscle) partially dies during a heart attack, a layer of muscle may survive, and being severely weakened, start to become an aneurysm. The blood may flow into the surrounding dead muscle and inflate the weakened flap of muscle into a bubble.
Signs and symptoms
Ventricular aneurysms usually grow at a very slow pace, but can still pose problems. Usually this type of aneurysm grows in the left ventricle. This bubble has the potential to block blood flow to the body, and thus limit the patient's stamina. In other cases, a similarly developed pseudoaneurysm "false aneurysm" may burst, sometimes resulting in death of the patient. Also, blood clots may form on the inside of ventricular aneurysms, and form embolisms. If these blood clots escape from the aneurysm, they will be moved in the circulation throughout the body. If these blood clots get stuck inside a blood vessel, they may cause ischemia in a limb, a painful condition that can lead to reduced movement and tissue death in the limb. Alternatively, if they block a vessel going to the brain, they can cause a stroke. In certain cases, ventricular aneurysm may cause ventricular failure or arrythmia. At this stage, treatment is necessary.
Investigations
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This section requires expansion. (November 2013) |
Treatment
Treatment is limited to surgery (ventricular reduction) for this defect of the heart. However, surgery is not required in most cases but, limiting the patient's physical activity levels to lower the risk of making the aneurysm bigger is advised. Also ACE Inhibitors seem to prevent Left Ventricular remodeling and aneurysm formation.
References
- ^ Victor F. Froelicher; Jonathan Myers (2006). Exercise and the heart. Elsevier Health Sciences. pp. 138–. ISBN 978-1-4160-0311-3. Retrieved 10 October 2010.
- Lohr, John T. "Ventricular Aneurysm: Treatment". Answers.com. Retrieved 22 September 2009.
- Lohr, John T. "Ventricular Aneurysm". Answers.com. Retrieved 22 September 2009.
- Graber, J.D.; Oakley, C.M.; Pickering, B.N.; Goodwin, J.F.; Raphael, M.J.; Steiner, R.E. "Ventricular aneurysm. An appraisal of diagnosis and surgical treatment.". British Heart Journal. PubMed. Retrieved 22 September 2009.
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Cardiovascular disease I00–I52, 390–429
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| Ischaemic |
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Coronary disease
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- Coronary artery disease (CAD)
- Coronary artery aneurysm
- Coronary artery dissection
- Coronary thrombosis
- Coronary vasospasm
- Myocardial bridge
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Active ischemia
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- Angina pectoris
- Prinzmetal's angina
- Stable angina
- Acute coronary syndrome
- Myocardial infarction
- Unstable angina
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Sequelae
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- hours
- Hibernating myocardium
- Myocardial stunning
- days
- weeks
- Aneurysm of heart / Ventricular aneurysm
- Dressler syndrome
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| Layers |
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Pericardium
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- Pericarditis
- Acute
- Chronic / Constrictive
- Pericardial effusion
- Cardiac tamponade
- Hemopericardium
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Myocardium
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- Myocarditis
- Cardiomyopathy: Dilated (Alcoholic), Hypertrophic, and Restrictive
- Loeffler endocarditis
- Cardiac amyloidosis
- Endocardial fibroelastosis
- Arrhythmogenic right ventricular dysplasia
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Endocardium /
valves
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Endocarditis
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- infective endocarditis
- Subacute bacterial endocarditis
- non-infective endocarditis
- Libman–Sacks endocarditis
- Nonbacterial thrombotic endocarditis
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Valves
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- mitral
- regurgitation
- prolapse
- stenosis
- aortic
- tricuspid
- pulmonary
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Conduction /
arrhythmia |
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Bradycardia
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- Sinus bradycardia
- Sick sinus syndrome
- Heart block: Sinoatrial
- AV
- Intraventricular
- Bundle branch block
- Right
- Left
- Left anterior fascicle
- Left posterior fascicle
- Bifascicular
- Trifascicular
- Adams–Stokes syndrome
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Tachycardia
(paroxysmal and sinus)
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Supraventricular
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- Atrial
- Junctional
- AV nodal reentrant
- Junctional ectopic
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Ventricular
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- Accelerated idioventricular rhythm
- Catecholaminergic polymorphic
- Torsades de pointes
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Premature contraction
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- Atrial
- Junctional
- Ventricular
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Pre-excitation syndrome
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- Lown–Ganong–Levine
- Wolff–Parkinson–White
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Flutter / fibrillation
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- Atrial flutter
- Ventricular flutter
- Atrial fibrillation
- Ventricular fibrillation
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Pacemaker
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- Ectopic pacemaker / Ectopic beat
- Multifocal atrial tachycardia
- Pacemaker syndrome
- Parasystole
- Wandering pacemaker
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Long QT syndrome
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- Andersen–Tawil
- Jervell and Lange-Nielsen
- Romano–Ward
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Cardiac arrest
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- Sudden cardiac death
- Asystole
- Pulseless electrical activity
- Sinoatrial arrest
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Other / ungrouped
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- hexaxial reference system
- Right axis deviation
- Left axis deviation
- QT
- T
- ST
- Osborn wave
- ST elevation
- ST depression
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| Cardiomegaly |
- Ventricular hypertrophy
- Left
- Right / Cor pulmonale
- Atrial enlargement
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| Other |
- Cardiac fibrosis
- Heart failure
- Diastolic heart failure
- Cardiac asthma
- Rheumatic fever
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Index of the heart
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| Description |
- Anatomy
- Physiology
- Development
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| Disease |
- Injury
- Congenital
- Neoplasms and cancer
- Other
- Symptoms and signs
- Blood tests
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| Treatment |
- Procedures
- Drugs
- glycosides
- other stimulants
- antiarrhythmics
- vasodilators
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UpToDate Contents
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English Journal
- Kawasaki Disease With Giant Coronary Aneurysms Requiring a Ventricular Assist Device to Separate From Extracorporeal Membrane Oxygenation: Coronary Issues Can Be a Pediatric Problem Too!
- Adler AC1, Kodavatiganti R.
- A & A case reports.A A Case Rep.2016 Jun 15. [Epub ahead of print]
- Kawasaki disease, although common in children, may rarely affect the coronary arteries, leading to aneurysm formation and potential for coronary thrombus formation. Extremely rarely, coronary aneurysms from Kawasaki disease can thrombose, resulting in ischemic myocardium. We present a case of a 31-m
- PMID 27310902
- Giant aneurysm in coronary right ventricular fistula associated with severe tricuspid insufficiency in an adult.
- Ling Y1, Ruan W1, Tang M2, Lin K3.
- European heart journal.Eur Heart J.2016 Jun 7;37(22):1776. doi: 10.1093/eurheartj/ehw040. Epub 2016 Feb 22.
- PMID 26908945
- Visualization of perimembranous ventricular septal defect with ruptured sinus of Valsalva aneurysm by three-dimensional transesophageal echocardiography and multidetector three-dimensional computed tomography.
- Mahara K1, Saito M2, Fukumoto R3, Tamura H3, Kin H4, Takanashi S4.
- Journal of echocardiography.J Echocardiogr.2016 Jun 3. [Epub ahead of print]
- PMID 27260005
Japanese Journal
- Arrhythmogenic Isthmus Bounded with Post-Surgical Right Ventricular Aneurysm
- Irie Tadanobu,Kaneko Yoshiaki,Nakajima Tadashi,Kurabayashi Masahiko
- Internal Medicine 54(9), 1155-1156, 2015
- NAID 130005068324
- Potts shunt 閉鎖後の吻合部仮性動脈瘤再発に対して debranching TEVAR を施行した1例
- 流郷 昌裕,今川 弘,泉谷 裕則,八杉 巧,阪下 裕司
- 日本心臓血管外科学会雑誌 44(2), 82-86, 2015
- 患者は34歳女性．肺動脈閉鎖症/心室中隔欠損症（PA/VSD）に対する複数回の姑息手術，根治手術を経たのち，28歳時に，閉塞したPotts shunt（体肺動脈シャント）の大動脈吻合部の仮性動脈瘤に対して，人工心肺下にパッチ閉鎖を施行した．その後外来にて経過観察中に，頻回の喀血による貧血が生じ，入院となった．精査にて，上記吻合部仮性動脈瘤の再発を認めた．患者はこれまでに正中開胸，左側方開胸とも2回 …
- NAID 130005062371
- 心筋梗塞の亜急性期に生じた偽性仮性心室瘤に対して二重パッチによる閉鎖を施行した1例
- 新城 宏治,佐戸川 弘之,高瀬 信弥,瀬戸 夕輝,五十嵐 崇,籠島 彰人,藤宮 剛,横山 斉
- 日本心臓血管外科学会雑誌 44(2), 70-73, 2015
- 症例は65歳男性．亜急性心筋梗塞の診断で保存的加療中，房室ブロックによる意識消失発作を来たし，右冠動脈に緊急経皮的冠動脈インターベンションが施行された．その3週間後に心エコーおよびCT検査で仮性心室瘤を認め，手術となった．術中所見では心膜との強固な癒着を認め，中隔から下壁基部に壊死した心筋壁と偽性仮性心室瘤を認めた．手術は仮性瘤を切開し，同部を二重にパッチ閉鎖した．術後経過は良好であった．偽性仮性 …
- NAID 130005062368
Related Pictures
★リンクテーブル★
[★]
- 英
- ventricular aneurysm
- 同
- 心臓瘤 cardiac aneurysm
- 関
- 左室瘤、左心室瘤
概念
- 左室の表面が限局性に突出し、同時に内腔の膨出を伴った状態、あるいは左室造影上収縮期、拡張期の全経過を通じて本来の左室腔より膨隆しているものを心室瘤と呼ぶ。
病型
- 好発部位：左室前壁・心尖部
- 頻度：急性心筋梗塞例の5-10%に見られる。
- 予後：急性期には破裂することがあるが、慢性期には破裂することはないが、不整脈のfocusとなり致死性不整脈を起こしたり、壁在血栓を形成し血栓塞栓症を発症しうる。
- 仮性心室瘤：心室壁の破裂に伴う血栓の周辺部が心嚢と癒着・線維化して瘤壁を形成
- 好発部位：後壁に好発
- 予後：破裂の危険が高く緊急手術の適応
疫学
病因
- 心筋梗塞(最多)
- 先天性・外傷性・細菌性心内膜炎による心筋膿瘍
検査
- 心エコー
- 心電図：心筋梗塞発症後に異常Q波が出現する誘導でST上昇が持続するときには、壁運動異常(akinesis/dyskinesis)が生じていると考えられ、心室瘤が疑われる。(ECGP.177) (普通ST上昇は数日の経過で正常化(cf.心筋梗塞#心電図の異常波形と時間経過 )
治療
手術療法
- 心室瘤切除術
- ドール手術：心筋梗塞後左室瘤に対する左室形成術
- Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F., Left ventricular aneurysm: a new surgical approach., Thorac Cardiovasc Surg. 1989 Feb;37(1):11-9.
- PMID: 2522252
[★]
心室瘤
- 関
- cardiac aneurysm、ventricular aneurysm
[★]
- 関
- cardiac ventricle、cerebral ventricle、cerebroventricle、cerebroventricular、heart ventricle、ventricle、ventriculi、ventriculus
