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Case 4: Infective Endocarditis > Aneurysm > Flashcards

Aneurysm Flashcards

1
Q

Definition of aneurysm

A

Localised abnormal permanent dilation of blood vessels/heart

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2
Q

What is the 5 causes of an aneurysm

A

Atherosclerosis
Hypertension
Trauma
Congenital defect (SLE, RA or connective tissue defect)
Vasculitis

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3
Q

2 types of aneurysm with layer involvement & types

A
  1. True aneurysm:
    Media & adventitia involved
    Types:
    Fusiform: both walls of aorta is dilated
    Saccular/berry: one wall dilated at circle of Willis
    Dissection: internal force making a tear in intima due to systemic hypertension
  2. False aneurysm:
    Adventitia/pericardium involved
    Types:
    External force: trauma forming large hematoma
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4
Q

What is the 3 aetiopathogenesis of an aneurysm

A
  1. Intrinsic quality of the vascular wall connective tissue is poor
  2. The balance of collagen degradation & synthesis is altered by local inflammatory infiltrates
  3. Vascular wall is weakened through loss of smooth muscle cells/inappropriate synthesis of ECM
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5
Q

4 complications of an aneurysm

A
  1. Rupture & potentially fatal haemorrhage
  2. Pressure of adjacent structures
  3. Thromboembolism
  4. Ischaemia distal to aneurysm
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6
Q

Describe aortic dissection

A

A rupture from the inside
Dissection of blood between laminar planes of the tunica media leading to blood filled channels in the media

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7
Q

Describe the 2 types of cardiac aneurysm

A

True aneurysm due to infarction
False aneurysm due to rupture of myocardium & containment of rupture by pericardium

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8
Q

What causes berry aneurysm & where does it occur

A

A congenital defect in muscular layer of circle of Willis
Tend to occur at the branches

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9
Q

In what population does abdominal aortic aneurysm occur

A

Atherosclerosis & smoking men over 50

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10
Q

In what 3 population is thoracic aortic aneurysm associated with

A

Associated with HPT, atherosclerosis & Marfans syndrome

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11
Q

Classify vasculitis aneurysm into 2 groups

A

Non-infective: due to autoimmune like SLE, RA, polyarteritis nodosa & Takayasu’s arteritis
Infective: syphilitis & mycotic

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12
Q

2 places a mycotic aneurysm can originate from

A

Originate from septic emboli from infective endocarditis (injure surrounding structures) or adjacent suppuration processes (small rupture)

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13
Q

Describe when & where syphilitic aneurysm occur

A

Tertiary stage of syphilis & confined to aorta/aortic arch & can extend to aortic valve ring & cause aortic regurgitation

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14
Q

What is 3 examples where there is poor vascular wall connective tissue

A
  1. Marfan syndrome (febrilline synthesis defect)
  2. Ehler Danlos syndrome (collagen synthesis defect)
  3. Vitamin C deficiency (altered collagen cross linking)
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15
Q

What is 2 examples of collagen imbalance in degradation

A
  1. MMP released by macrophages in atherosclerotic plaque degrading ECM
  2. Decreased TIMMP levels
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16
Q

What is 2 examples of vascular wall weakened due to loss of muscle/inappropriate synthesis of ECM

A
  1. Atherosclerosis cause ischaemia to inner aspect of medial smooth muscle
  2. Smooth muscle loss result in scaring & replacement by amorphous ground substances
17
Q

What is the 2 population groups of aortic dissection

A
  1. Men w/ HPT
  2. Younger individuals w/ connective tissue abnormalities
18
Q

What is the 2 consequences of aortic dissection

A
  1. Rupture through adventitia
  2. Double barreled aorta when it re-enters aorta
19
Q

What happens when a Berry aneurysm rupture

A

Subarachnoid haemorrhage

20
Q

Where does abdominal aortic aneurysm occur

A

Below level of renal artery

21
Q

How is abdominal aortic aneurysm management

A

Surgical bypass if bigger than 5cm or growing more than 0.5cm/year
Rupture risk depends on size

22
Q

What is the 4 complications of abdominal aortic aneurysm

A
  1. Rupture w/ risk of fatal haemorrhage
  2. Obstruction of branching vessel causing distal ischaemia
  3. Embolus from thrombus or atheroma
  4. Impingement on adjacent structures
23
Q

What is the 3 complications of thoracic aortic aneurysm

A
  1. Respiratory difficulty due to compression
  2. Difficulty swallowing due to compression
  3. Rib & vertebrae erosion
24
Q

Explain how a syphilitic aneurysm occur

A

Adventitial inflammation of vasa vasorum to obliterative arteritis to ischemic media & loss of elastic fibers resulting in weakening of vessel wall

Case 4: Infective Endocarditis (10 decks)

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