ANEURYSM AND DISSECTION

Question 1

DEFINE ANEURYSM

Answer 1

LOCALISED ABNORMAL DILATION OF A BV OR THE HEART

Question 2

TYPES OF ANEURYSM

Answer 2

TRUE ANEURYSM
FALSE ANEURYSM

Question 3

DEFINE TRUE ANEURYSM

Answer 3

ATTENUATED BUT INTACT ARTERIAL WALL OR THINNED VENTRICLE WALL OF THE HEART

Question 4

CLASSIFICATION OF TRUE ANEURYSM

Answer 4

BASED ON SIZE AND SHAPE

SHAPE:
SACCULAR ANEURYSM - HAVE SPHERICAL OUTPOUCHING OFTEN CONTAIN THROMBUS
FUSIFORM ANEURYSM - DIFFUSE, CIRCUMFERENTIAL DILATATIONS

Question 5

FALSE ANEURYSM ALSO KNOWN AS

Answer 5

PSEUDO ANEURYSM

Question 6

DEFINE FALSE ANEURYSM

Answer 6

DEFECT OF THE VASCULAR WALL CAUSING THE EXTRAVASCULAR HEMATOMA IN WHICH IT FREELY COMMUNICATES THE INTRAVASCULAR SPACE RESULTING IN PULSATING HEMATOMA

Question 7

EXAMPLE OF FALSE ANEURYSM

Answer 7

VENTRICULAR RUPTURE AFTER MI

Question 8

PATHOGENESIS OF ANEURYSM

Answer 8

1. INTRINSIC QUALITY OF THE VASCULAR WALL CONNECTIVE TISSUE IS POOR
2. THE BALANCE OF SYNTHESIS AND DEGRADATION OF THE COLLAGEN IS ALTERED BY THE INFLAMMATION AND ACQUIRED PROTEASES
3. THE VASCULAR WALL IS WEAKENED THROUGH THE LOSS OF SMC OR THE SYNTHESIS OF THE NON COLLAGENOUS AND NON ELASTIC ECM

Question 9

STATE EXAMPLE OF DISORDERS THAT HAS POOR INTRINSIC QUALITY OF THE VASCULAR WALL CONNECTIVE TISSUE.

Answer 9

1. MARFAN’S SYNDROME
2. LOEYS-DIETZ SYNDROME
3. EHLER DANLOS SYNDROME
4. VITAMIN C DIFFICIENCY

Question 10

MAIN CAUSE OF AAA

Answer 10

ATHEROSCLEROSIS

Question 11

MAIN CAUSE OF TAA

Answer 11

HPT

Question 12

OTHER DISORDER THAT CAN LEAD TO ANEURYSM

Answer 12

TERTIARY SYPHILIS
TRAUMA
VASCULITIS
CONGENITRAL DEFECT SUCH AS BERRY ANEURYSM, FIBROMUSCULAR DYSPLASIA
INFECTIONS (MYCOTIC ANEURYSM)

Question 13

CF OF AAA

Answer 13

1. ASYMPTOMATIC
2. RUPTURE INTO THE PERITONEAL CAVITY @ RETROPERITONEAL TISSUE - FATAL HAEMORRHAGE
3. OBSTRUCTION OF THE VESSEL BRANCHING OFF FROM THE AORTA -> ISCHEMIC INJURY TO THE SUPPLIED TISSUE
4. EMBOLISM FROM ATHEROMA. OR MURAL THROMBOSIS
5. IMPINGEMENT ON AN ADJACENT PLEURA.

Question 14

TAA IS MOST COMMONLY IN

Answer 14

HPT

Question 15

OTHER CAUSES OF TAA

Answer 15

MARFAN’S SYNDROME
LOEYS-DIETZ SYNDROME

Question 16

SIGN AND SYMPTOMS OF TAA

Answer 16

1. RESPIRATORY DIFFICULTIES - D/T ENCROACHMENT OF THE LUNGS AND AIRWAYS
2. SWALLOWING DIFFICULTIES - D/T ENCROACHMENT OF THE OESOPHAGUS
3. PERSISTENT COUGH - D/T COMPRESSION OF THE RLN
4. PAIN - D/T EROSION OF THE BONES
5. CARDIAC DISEASE - D/T AORTIC ANEURYSM -> AORTIC VAVLE DILATION + VALVULAR INSUFFICIENCY / NARROWING OF THE CORONARY OSTIUM -> MYOCARDIAL ISCHEMIA
6. RUPTURE - EX: SYPHILIS ANEURYSM USUALLY DIE D/T CARDIAC FAILURE SECONDARY TO AORTIC VALVULAR INCOMPETENCE.

Question 17

DEFINE AORTIC DISSECTION

Answer 17

ARISES WHEN BLOOD ENTER A DEFECT OF THE ARTERIAL WALL AND TUNNEL BETWEEN ITS LAYER

Question 18

AORTIC DISSECTION USUALLY OCCUR IN

Answer 18

• INDIVIDUALS AGE 40 TO 60 WITH ANTECEDENT HPT
• YA WITH SYSTEMIC OR LOCALISED ABNORMALITIES OF THE CT THAT AFFECT THE AORTA

Question 19

OTHER CAUSES OF AD

Answer 19

• IATROGENIC
• DURING CORONARY CATHETHERISATION PROCEDURES
• CARDIOPULMONARY BYPASS
• PREGNANCY

Question 20

PATHOGENESIS OF AD

Answer 20

1. HPT USUALLY THE COMMON CAUSE OF AD
2. MEDIAL HYPETROPHY OF THE VASA VASORUM + DEGENERATIVE CHANGES SUCH AS LOSS OF MEDIAL SMC AND DISORGANISED ECM
3. ONCE A TEAR OCCURED, THE BLOOD FLOW UNDER SYSTEMIC PRESSURE DISSECT THROUGH THE MEDIA -> HEMATOMA

Question 21

MORPHOLOGY OF AD

Answer 21

• CYSTIC MEDIAL DEGENERATION
• INITIATE WITH AN INTIMAL TEAR
• DISSECTION CAN EXTEND RETROGRADE TOWARD THE HEART AS WELL AS DISTALLY SOMETIME INTO THE ILLIAC AND FEMORAL ARTERIES
• DISSECTING HEMATOMA SPREADS ALONG THE LAMINAR PLANES OF THE AORTA USUALLY BTWN MIDDLE AND OUTER THIRDS

Question 22

COMPLICATION OF AD

Answer 22

• RUPTURE THROUGH THE ADVENTITIA -> MASSIVE HAEMORRHAGE
• DISSECTING HEMATOMA REENTER THE LUMEN OF THE AORTA THROUGH 2ND DISTAL INTIMAL TEAR CREATING NEW FALSE VASCULAR CHANNEL (DOUBLE BARRELED AORTA)

Question 23

CM OF AD

Answer 23

• SUDDEN ONSET OF EXCRUCIATING PAIN
• PAIN START IN THE ANT CHEST, THEN RADIATE TO THE BACK BTWN THE SCAPULA, THEN MOVE DOWNWARD AS THE DISSECTION PROGRESS
• PAIN CAN BE CONFUSED WITH MI
• RETROGRADE DISSECTION INTO THE AORTIC ROOT CAN DISRUPT THE AORTIC VALVE ANNULUS
• DISSECTION CAN EXTEND INTO THE GREAT ARTERIES OF THE NECK OR INTO THE CORONARY, RENAL, MESENTERIC, OR ILIAC ARTERIES CAUSING VASCULAR OBST. AND ISCHAEMIC CONSEQUENCES SUCH AS MI

Question 24

COMPLICATIONS OF AD.

Answer 24

1. TYPE I AND II DEBAKEY CLASSIFICATION IN WHICH THE DISSECTION INVOLVE THE ASCENDING AORTA AND DESCENDING AORTA OR ASCENDING AORTA ONLY (PROXIMAL LESION- COMMON AND DANGEROUS)
2. TYPE III DEBAKEY CLASSIFICATION IN WHICH THE DISSECTION INVOLVE THE DESCENDING AORTA ONLY. (DISTAL LESION - LESS COMMON)