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Pathology-Cardio > Aneurysms and dissections > Flashcards

Aneurysms and dissections Flashcards

1
Q

aneurysms are

A

-Aneurysms are dilatations of the aorta due

to weakening of the wall

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2
Q

dissections are

A

-Dissections (also called dissecting aneurysms)
lead to widening of the vessel as the result
of blood dissecting through the wall of the
vessel

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3
Q

aneurysms most commonly occur

A

in the abdominal aorta distal to the renal arteries

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4
Q

causes of aneurysms

A
  1. atherosclerotic weakening of the wall of the aorta
    2.also occur as a result of infection, vasculitis, or structural abnormalities
    -syphilis: aneurysms of the ascending (thoracic) aorta
    -genetic abnormalities of collagen, elastin: ascending
    aorta
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5
Q

how do dissections occur?

A

as a result of blood passing through a tear in the intima
-dissections split the vascular media and create a false
vascular channel

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6
Q

dissections most commonly occur in

A

thoracic aorta

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7
Q

dissections are most commonly associated with?

A

hypertension

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8
Q

death from dissections are caused by?

A

hemopericardium and cardiac tamponade

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9
Q

what is a true aneurysm?

A

bounded by generally complete but attenuated arterial wall components

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10
Q

what is a false aneurysm?

A
  • (pseudoaneurysm) – widening due to extravascular hematoma that communicates with the lumen (dissection)
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11
Q

atherosclerosis as a cause of aneurysms

A

-usually positioned below the renal arteries and above the
bifurcation of the aorta
-often associated with dilatations of the iliac arteries
-may affect origins of the renal, superior, and inferior
mesenteric arteries
-thinning and destruction of media resulting from
ulceration of atherosclerotic areas
-cylindrical aneurysms which may rupture
-increased diameter increases risk; 50% mortality
-risk of rupture for small aneurysm 2%
-develop after 50; much more common in men
-familial (other than atherosclerosis or
hypertension)

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12
Q

consequences of abdominal aneurysms

A

-rupture - peritoneal cavity or retroperitoneal
tissues
-impingement on an adjacent structure
-occlusion of a vessel be either direct pressure or
mural thrombus
-vertebral branches that supply the spinal cord
-embolism from the atheroma or mural thrombus
-abdominal mass that simulates a tumor

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13
Q

berry aneurysms

A

congenital weakness of arterial wall (usually CNS)
-outpoouching
-usually sporadic
-sometimes associated with autosomal dominant
(adult form) polycystic kidney disease
-also associated with Ehlers-Danlos syndrome
-most common around circle of Willis
-anterior communicating artery(40%)>middle
cerebral artery (34%)>junction of
carotid/posterior communicating artery (20%)
-bifurcations of cerebral arteries

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14
Q

vasculitic aneurysms

A

-Kawasaki, Wegener’s, temporal arteritis, Takayasu’s etc

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15
Q

mycotic aneurysms

A

Salmonella gastoenteritis

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16
Q

thoracic aorta aneurysms

A
  • syphilitic
  • genetic tissue disorders – Marfan’s, Ehlers-Danlos, etc.
  • bicuspid aortic valve
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17
Q

what is the most common rupture in young adults?

A

berry aneurysms

  • causes subarachnoid hemorrhage
  • occurs with acute increases in arterial pressure, as will weight lifting
18
Q

those with berry aneurysms present with

A
  • acute, severe headache
  • transient loss of consciousness
  • associated with reactive cerebral vasospasm
19
Q

consequences of a thoracic aneurysm

A

-encroachment on mediastinal structures
-respiratory difficulties
-difficulty in swallowing/compression of esophagus
-persistent cough due to irritation of or pressure on the
recurrent laryngeal nerves
-incompetence of aortic valve at aortic root
-rupture of the aneurysm – hemopericardium with
cardiac tamponade

20
Q

dissections leads to what kind of aneurysm

A

false aneurysm
-actually a misnomer; most dissections occur without
significant aneurysm

21
Q

how are the locations of dissections different from aneurysms?

A

usually affects ascending and proximal aorta with
intimal tear within 10 cm of aortic valve
-associated with hypertension; Marfans, Ehlers-Danlos
-tears are usually transverse or oblique, 1-5 cm long
-produces false channel

22
Q

where do dissecting intramural hematomas form?

A

-characteristically between middle and outer

thirds of the media

23
Q

what is the most common cause of death with dissections?

A

death is rupture into body cavity (pericardial, pleural, peritoneal)
*hemopericardium is most common cause of death

24
Q

what are the common manifestations in dissections?

A

-cardiac tamponade, aortic insufficiency, myocardial infarction

25
Q

classic symptoms of dissections

A

-include sudden onset of excruciation pain, usually beginning in the anterior chest, radiating to the back, and moving downwards as the dissection progresses; often
confused with acute myocardial infarction

26
Q

what do complications depend on with dissections?

A

level of aorta affected
-proximal lesions more common (and dangerous)
-second type include distal lesions (usually beginning
distal to subclavian artery)

27
Q

Cystic medial necrosis

A

-non-specific term for several etiologies

28
Q

characteristic changes with cystic medial necrosis

A

-elastic tissue fragmentation and disruption
-focal separation of elastic and fibromuscular elements
-small cleft-like or cystic spaces WITH AMORPHOUS
MATERIAL; INFLAMMATION IS ABSENT
-characteristic of Marfan’s and other collagen diseases
-may be associated with fusiform aneurysms or aortic
dissection

29
Q

why is cystic medial necrosis an inaccurate name?

A

necrosis is not present

30
Q

Marfan’s

A

-autosomal dominant disease of connective tissue
fibrillin
-skeletal, cardiovascular, and ocular manifestations
-dilatation and dissection of aortic root; mitral
valve prolapse

31
Q

Ehler’s-Danlos Syndrome

A
  • Heterogeneous group of collagen disorders

- Several subtypes: joint, skin, and vascular phenotypes

32
Q

extreme phenotypes of Ehler’s-Danlos syndrome

A

-include “circus” freaks demonstrating joint hypermobility and stretching of skin
* most patients do not demonstrate such extreme
phenotypes; many are missed because doctor’s are
looking for freaks

33
Q

symptoms of Ehler’s-Danlos syndrome

A
  • involve joints, skin, large blood vessels
  • frequent dislocations, joint injuries
  • easy bruising, delayed wound healing
  • scoliosis, near-sightedness, gum disorders
34
Q

what causes death in E-D syndrome

A
  • vascular aneurysms (berry aneurysm, thoracic aneurysms), uterine, bladder, or intestinal rupture
  • treatment of hypertension essential
  • anticipation of complications (childbirth)
35
Q

Syphilis (Luetic aneurysms)

A

-associated with tertiary syphilis
-nearly always confined to thoracic aorta; usually
involving the arch
*may involve aortic root with aortic valve insufficiency
*occlusion or narrowing of coronary ostia

36
Q

Cor Bovinum

A

greatly enlarged heart secondary to aortic valve insufficiency

37
Q

pathophysiology in Luetic aneurysms

A

-inflammation of adventitia; obliterative endarteritis
of the vasa vasorum with infiltrate of lymphocytes
and plasma cells
-secondary ischemic injury of aortic media with
patchy loss of medial elastic fibers and muscle
cells; inflammatory scarring of the media
-associated with both aneurysmal dilatation and
dissection
-treebarking of the aortic intima results from
segmental wrinkling due to scar contraction

38
Q

Arteriovenous fistulas

A

anomalous connection between artery and vein
-may be congenital or secondary to trauma,
inflammation, etc.
-can cause significant left to right shunts,
overloading the right side of the heart and
causing right heart failure
-can also rupture and cause significant bleeding
(cerebral aneurysm)
-presents as stroke (younger population)

39
Q

What are the signs of a ruptured berry aneurysm

A

Headache
Subarachnoid hemorrhage
Blood in CSF

40
Q

Berry aneurysms are seen with

A

Marfans
Ehlers danlos
Polycystic kidney disease (autosomal recessive in Kids, dominant in adults)

41
Q

Berry aneurysms most commonly occur in

A

Around circle of Willis
Anterior communicating artery> middle cerebral artery>junction of carotid/ posterior communicating artery
Bifurcations of cerebral arteries

Pathology-Cardio (11 decks)

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