A 54-year-old man with uncontrolled hypertension presents with progressive exertional dyspnea and hoarseness. Vital signs show BP 168/95 mmHg, HR 102/min, RR 20/min, SpO2 96% on room air. Cardiac examination reveals a high-pitched early diastolic murmur. Chest X-ray demonstrates aneurysmal dilation of the ascending thoracic aorta with a widened mediastinum. Pulmonary examination is clear to auscultation bilaterally. Which mechanism best explains his acute decompensated heart failure?
- A)Inflammatory thrombosis of small and medium vessels in smokers
- B)Obliterative endarteritis of the vasa vasorumGABARITO
- C)Atherosclerotic destruction of the infrarenal aorta
- D)Cystic medial degeneration due to fibrillin defect
- E)Intimal tear with blood dissecting along the media
Explicação
Obliterative endarteritis of the vasa vasorum is correct. Tertiary syphilis causes inflammation and ischemic injury of the ascending aortic media by damaging the vasa vasorum, leading to thoracic aneurysm and possible aortic regurgitation. Hoarseness can resul... Ver explicação completa e trilha adaptativa →