Why is angina not a typical symptom of left ventricular aneurysm?

Why is angina not a typical symptom of left ventricular aneurysm?

Angina pectoris indicates viable but ischemic myocardium. In ventricular aneurysm, it is usually a non-viable scarred area of myocardium, due to poorly collateralized chronically occluded coronary artery. The border zone of the aneurysm is vulnerable to form re-entrant circuits which can trigger ventricular tachycardia. As the aneurysmal segment bulges out in systole instead of contracting, the systolic effort of the left ventricle is wasted. Part of the effort of the remaining left ventricular muscle is wasted in moving blood in and out of the aneurysm pouch. This leads to heart failure. Mural thrombi can form in the wall of the scarred aneurysm and lead to embolization.