syphilitic aneurysm

[neurology2015]

In syphilitic aneurysm it affects ascending aorta but does it actually form an aneurysm there? And if it does, is it the aneurysm that causes aortic regurgitation?

And if it does indeed cause aortic regurgitation, one can potentially diagnose it because its gonna cause a wide pulse pressure?

And rheumatic heart disease causes mitral stenosis and aortic valve stenosis? it doesnt cause aortic regurgitation? right?

 

[ERPCT]

It is the resultant root dilation that causes the regurgitation. It would be on your differential for a widened pulse pressure. Rheumatic heart disease causes mitral regurgitation which may progress to mitral stenosis, and less commonly aortic stenosis. If it does indeed cause aortic stenosis, the mitral valve will almost always be involved as well.

 

[Instatewaiter]

In syphilitic aneurysm it affects ascending aorta but does it actually form an aneurysm there? And if it does, is it the aneurysm that causes aortic regurgitation?

And if it does indeed cause aortic regurgitation, one can potentially diagnose it because its gonna cause a wide pulse pressure?

And rheumatic heart disease causes mitral stenosis and aortic valve stenosis? it doesnt cause aortic regurgitation? right?

Yes it forms an ascending aortic aneurysm. If there is enough root dilation, it will cause AI. A wide pulse pressure in AI occurs chronically. Wide pulse pressure from the AI is probably the last way you are going to diagnose a syphlitic aneurysm for a few reasons. First, wide pulse pressure is pretty common and is caused by common things like aging, sepsis. Second and more importantly, the AI caused by a rapidly enlarging aneurysm is going to be acute AI. Acute AI usually doesn't cause a very wide pulse pressure (usually normal).

Rheumatic heart disease can cause both regurgitant and stenotic lesions. MS isn't caused by too much, so if there's MS it's probably rheumatic heart disease. AS is common and caused by a ton of things, most commonly aging. If the rheumatic disease affects the anterior or posterior mitral valve leaflet more than the other, you get MR. Same thing goes for the aortic cusps. For instance, if the non-coronary cusp becomes more affected with calcification, it won't coapt right and you get AI.