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Case 6: Left ventricular aneurysm

A 55-year-old man was referred to the cardiac transplant unit with incapacitating angina and end-stage heart failure due to ischaemic dilated cardiomyopathy. He had a transmural anteroseptal myocardial infarct five years before.

On physical examination a dyskinetic, displaced apex beat was noted and the chest x-ray (images below) showed cardiomegaly with a large, calcified apical aneurysm. Left ventricular angiography revealed a thrombus in the aneurysm.

The patient eventually underwent PTCA of the left circumflex as treatment for the angina and was not accepted for transplantation because of severe peripheral vascular disease.