Evolution of the responses to exercise in left ventricular aneurysms after anterior wall acute myocardial infarction

The evolution of the heart rate, blood pressure and electrocardiographic responses to exercise in 20 patients (group A) who exhibited echocardiographic evidence of left ventricular (LV) aneurysms after acute myocardial infarction (AMI) were examined. The responses were compared with those seen in 19 patients without LV aneurysms who were matched for age, gender and location of infarct (group B). Patients taking beta blockers were excluded from the study. It was found that the heart rate response to exercise was accentuated in group A at the time of discharge from hospital and that it became attenuated over 9 to 12 months. The blood pressure response was significantly increased over 9 to 12 months in group B. Persistence of ST elevation during exercise, 10 to 12 weeks after AMI, was diagnostic of an LV aneurysm. One year after AMI the sensitivity of ST elevation was 90%, specificity was 95% and the negative predictive value 90%.