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Left ventricular aneurysm on echocardiography

A thin, bright segment that is deformed in diastole as well as systole and bulges outward as the rest of the ventricle contracts. Most often apical (LAD) or inferobasal.

Watch it in the simulator →Practise random cases

Where to look

Apical views for apical aneurysms (apical 2-chamber and 4-chamber), apical 2-chamber and PLAX for inferobasal or inferolateral aneurysms.

Typical wall-motion pattern

Right ventricleRV1. Basal anterior — Normal12. Basal anteroseptal — Normal23. Basal inferoseptal — Normal34. Basal inferior — Normal45. Basal inferolateral — Normal56. Basal anterolateral — Normal67. Mid anterior — Akinetic78. Mid anteroseptal — Hypokinetic89. Mid inferoseptal — Normal910. Mid inferior — Normal1011. Mid inferolateral — Normal1112. Mid anterolateral — Normal1213. Apical anterior — Aneurysmal1314. Apical septal — Aneurysmal1415. Apical inferior — Aneurysmal1516. Apical lateral — Dyskinetic1617. Apex (apical cap) — Aneurysmal17ANTINFSEPLAT
4C3. Basal inferoseptal — Normal39. Mid inferoseptal — Normal914. Apical septal — Aneurysmal1417. Apex (apical cap) — Aneurysmal1716. Apical lateral — Dyskinetic1612. Mid anterolateral — Normal126. Basal anterolateral — Normal6Right ventricleRVSEPLAT2C4. Basal inferior — Normal410. Mid inferior — Normal1015. Apical inferior — Aneurysmal1517. Apex (apical cap) — Aneurysmal1713. Apical anterior — Aneurysmal137. Mid anterior — Akinetic71. Basal anterior — Normal1INFANT3C5. Basal inferolateral — Normal511. Mid inferolateral — Normal1116. Apical lateral — Dyskinetic1617. Apex (apical cap) — Aneurysmal1713. Apical anterior — Aneurysmal138. Mid anteroseptal — Hypokinetic82. Basal anteroseptal — Normal2Right ventricleRVINF-LATANT-SEPSAX baseRight ventricleRV1. Basal anterior — Normal12. Basal anteroseptal — Normal23. Basal inferoseptal — Normal34. Basal inferior — Normal45. Basal inferolateral — Normal56. Basal anterolateral — Normal6SAX midRight ventricleRV7. Mid anterior — Akinetic78. Mid anteroseptal — Hypokinetic89. Mid inferoseptal — Normal910. Mid inferior — Normal1011. Mid inferolateral — Normal1112. Mid anterolateral — Normal12

Example: Apical aneurysm (LAD)

Aneurysmal: apical anterior, apical septal, apical inferior, apex (apical cap) · Dyskinetic: apical lateral · Akinetic: mid anterior · Hypokinetic: mid anteroseptal

EF in this example: 37% (Impaired (36–49%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 27% to 41% (median 33%, Severely impaired (≤35%)). Every case in the simulator is different, so practise until your visual estimate lands in the right 5% range.

Variants you will see

Teaching points

Common pitfalls

Dyskinesia bulges outward only in systole; an aneurysm is also deformed in diastole and is usually thin and bright.

Try it now: open the LV aneurysm (post-infarct) example with the segment overlay, then test yourself in Practice where cases are random and graded against the exact answer.

Other patterns