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Aneurysm

An aneurysm (or aneurism) (from Greek ανευρυσμα, a dilatation) is a localized dilation or ballooning of a blood vessel by more than 50% of the diameter of the vessel. Aneurysms most commonly occur in the arteries at the base of the brain (the circle of Willis) and in the aorta (the main artery coming out of the heart) - this is an aortic aneurysm. more...

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The layer of the artery that is in direct contact with the flow of blood is the tunica intima, commonly called the intima. This layer is made up of mainly endothelial cells. Adjacent to this layer is the tunica media, known as the media. This "middle layer" is made up of smooth muscle cells and elastic tissue. The outermost layer (farthest from the flow of blood) is known as the tunica adventitia or the adventitia. This layer is composed of connective tissue.

Types

Aneurysms are also described according to their shape: Saccular or fusiform. Aneurysms can be broken down into two groups: true aneurysms and false aneurysms. A true aneurysm involves an outpouching of all three layers of a blood vessel: the intima, the media, and the adventitia. True aneurysms can be due to congenital malformations, infections, or hypertension. A false aneurysm, also known as a pseudoaneurysm, involves an outpouching of only the adventitia. Pseudoaneurysms can be due to trauma involving the intima of the blood vessel, and are a known complication of percutaneous arterial procedures.

Locations

Aneurysms can occur anywhere where there is a blood vessel, although they are most common in arteries. Most non-intracranial aneurysms (95%) arise distal to the origin of the renal arteries at the infrarenal abdominal aorta, a condition mostly caused by atherosclerosis. The thoracic aorta can also be involved. One common form of thoracic aortic aneurysm involves widening of the proximal aorta and the aortic root, which leads to aortic insufficiency. Aneurysms occur in the legs also, particularly in the deep vessels (e.g., the popliteal vessels in the knee). Arterial aneurysms are much more common, but venous aneurysms do happen (for example, the popliteal venous aneurysm).

  • While most aneurysms occur in an isolated form, the occurrence of berry aneurysms of the anterior communicating artery of the circle of Willis is associated with autosomal dominant polycystic kidney disease (ADPKD).
  • The third stage of syphilis also manifests as aneurysm of the aorta, which is due to loss of the vasa vasorum in the tunica adventitia.

Risks

Rupture and blood clotting are the risks involved with aneurysms. Rupture leads to drop in blood pressure, rapid heart rate, and lightheadedness. The risk of death is high except for rupture in the extremities. Blood clots from popliteal arterial aneurysms can travel downstream and suffocate tissue. Only if the resulting pain and/or numbness are ignored over a significant period of time will such extreme results as amputation be needed. Clotting in popliteal venous aneurysms are much more serious as the clot can embolise and travel to the heart, or through the heart to the lungs (a pulmonary embolism).

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Ventricular aneurysm
From Gale Encyclopedia of Medicine, 4/6/01 by John T. Lohr

Definition

Ventricular aneurysm is a complication of a heart attack (myocardial infarction). It is a ballooning of a section of a blood vessel in the heart that first appears several days or weeks after an acute myocardial infarction.

Description

A myocardial infarction occurs when a section of the heart wall is deprived of blood and dies (undergoes necrosis, or tissue death, and scarring). The heart wall is mainly muscle. It has two ventricles, the right and left ventricles, which pump blood to and from the lungs, and to the body. When part of the heart muscle dies, pumping power from that part of the wall is lost. After a myocardial infarction, the part of the heart wall that did not die must continue pumping blood and compensate for the dead muscle.

Ventricular aneurysm is one of the complications that follow a myocardial infarction.

An aneurysm is the outward swelling, or ballooning, of a blood vessel at a weak spot in the wall of the blood vessel. In the case of ventricular aneurysm, the aneurysm occurs in the wall of the heart at the spot where the myocardial infarction occurred. A scar usually forms in the area of the dead muscle tissue, and may eventually calcify. Ventricular aneurysms generally do not rupture. The left ventricle is involved in most cases of ventricular aneurysm.

Causes & symptoms

The principle symptom of a ventricular aneurysm is cardiac insufficiency, a condition in which not enough blood is being pumped to the body. Ventricular aneurysm is usually found after a large infarction in the muscle wall of a ventricle. Ventricular aneurysm is seldom seen immediately after a myocardial infarction. It takes several days or weeks to several months to develop. Frequently, recurrent ventricular irregular heartbeats (arrhythmias) and low cardiac output result from the presence of a ventricular aneurysm. Blood clots (thrombi) may form on the inside wall of the aneurysm and produce systemic blood clots that get stuck in a blood vessel (embolisms), which could lead to stroke or an ischemic leg (a usually painful condition in which lack of blood circulation leads to reduced function).

Diagnosis

A number of signs may indicate ventricular aneurysm, including an abnormal precordial impulse in the heartbeat, persistent elevation of the S-T segment of an electrocardiogram, and a characteristic bulge seen on the heart when x-rayed. The bulge is typically seen when the heart contracts, driving blood to the aorta, in the systolic phase of the heartbeat. Echolocation (echocardiography or ultrasound) can confirm the presence of an aneurysm. Cardiac catheterization may be performed to determine the extent of the aneurysm and the status of the coronary arteries. Stethoscopic examination reveals abnormal heart sounds, especially those associated with a backflow of blood from the left ventricle to the left atrium in systole or contraction beat (mitral regurgitation). This heart murmur is caused by the heart muscles no longer being able to properly operate the mitral valve.

Treatment

Most cases of ventricular aneurysm are treated by close medical follow-up and limiting patient activity. Surgical removal of the aneurysm is an option when persistent left ventricular failure or arrhythmia occurs, and the aneurysm is large. Vasodilators, diuretics, and digoxin are used to treat heart failure. Anticoagulant drugs are used to prevent the formation of blood clots. Antiarrhythmic drugs are used to treat heart arrhythmias.

Prognosis

Ventricular aneurysm occurs more frequently than is commonly thought. Based on postmortem examination, ventricular aneurysm occurs in as many as 15% of myocardial infarction cases. Patients with a large ventricular aneurysm in the left ventricle have a reduced survival rate. Many patients have mild symptoms which are not life-threatening. The survival rate is dependent on the function of the left ventricle.

Key Terms

Arrhythmia
A disturbance in the beating pattern of the heart.
Myocardial infarction
Commonly known as a heart attack, a myocardial infarction occurs when a part of the heart muscle is deprived of blood and dies.

Further Reading

For Your Information

    Books

  • Alexander, R.W., R. C. Schlant, and V. Fuster, eds. The Heart, 9th ed. New York: McGraw-Hill, 1998.
  • Gibler, W.B., and T.P. Aufderheide. Emergency Cardiac Care. St. Louis, MO: Mosby, 1994.
  • Giuliani, E.R., et al. Mayo Clinic Practice of Cardiology, 3rd ed. St. Louis, MO: Mosby, 1996.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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