Left Ventricular Aneurysm with Normal Coronary Vessels and Cardiac Mesothelial Excrescences

A 70 year old female was admitted to the Emergency Department of our Hospital after an episode of syncope, at home. The patient was resuscitated with chest compressions. The patient’s family history was clear. Her own medical history revealed a transient cerebral ischemic attack. No other significant disease was reported. Despite the detailed history taken, no history of thoracic pain, dyspnea or arrhythmia was reported. During clinical examination, the patient presented with a condition of cardiogenic shock (fall of arterial pressure, impalpable pulse, coldness, sweating, pale color and tendency to faint). The patient was supported with administration of fluids and dopamine, at an inotropic dose. With this treatment, she showed impressive clinical improvement after a short period. In the objective evaluation her arterial pressure was 90/60 mm Hg (under dopamine), pulse 100/ minute and she was not febrile. Heart auscultation presented low sounds without any additional sound or murmurs. Neck veins were dilated, while lungs auscultation did not reveal any rhonchi. The examination of the other systems did not present any pathological findings. ECG at admission (Figure 1) presented sinus rhythm and a Q wave with ST elevation at leads II, III, aVF as well as V1 -V5. The echocardiograph that followed showed extensive akinesis – dyskinesis of the apex of the left ventricle. The motility in the basal parts was satisfactory. No significant valve abnormalities were Left Ventricular Aneurysm with Normal Coronary Vessels and Cardiac Mesothelial Excrescences