When the vessel ruptures, surgery is the only intervention that can repair it. The techniques used for aneurysm surgery have for long been standardized. 95% of aneurysms are accessible via a small frontotemporal craniotomy centred over the pterion. Only occasional cases, principally aneurysms of the distal anterior cerebral artery and the lower vertebrobasilar trunk, require different surgical approaches.

Option A: Administration of antihypertensive medications can help control hypertension, reducing the risk of rupture. Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose-dependent relationship between the reduction of blood pressure and the prevention of aneurysmal rupture. Captopril and losartan were able to reduce the rupture rates without affecting systemic hypertension induced by DOCA-salt treatment.
Option B: An aortogram is a diagnostic tool used to detect an aneurysm. An aortogram is an invasive diagnostic test using a catheter to inject dye (contrast medium) into the aorta. X-rays are taken of the dye as it travels within the aorta, allowing clear visualization of blood flow. This way, any structural abnormalities of the aorta will be accurately seen.
Option C: Beta-blockers can slow the heartbeat, thereby decreasing blood pressure. Antihypertensives are used to reduce the rate of rise of the aortic pressure (dP/dt). For acute reduction of arterial pressure, the potent vasodilator sodium nitroprusside is very effective. To reduce dP/dt acutely, administer a beta-blocker intravenously (IV) in incremental doses until a heart rate of 60-80 beats/min is attained. When beta-blockers are contraindicated, as in second- or third-degree atrioventricular block, consider using calcium-channel blockers.

Cardiomyopathy isn’t usually related to underlying heart disease such as atherosclerosis. The etiology in most cases is unknown.

Option B: Coronary artery disease is directly related to atherosclerosis. Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis.
Option C: During the progression of atherosclerosis, myeloid cells destabilize lipid-rich plaque in the arterial wall and cause its rupture, thus triggering myocardial infarction.
Option D: Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure.

Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. The condition may result from a pre-existing cardiomyopathy not apparent prior to pregnancy.

Option B: Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency.
Option C: Myocarditis isn’t specifically associated with childbirth. Myocarditis is an inflammation of the heart muscle (myocardium). Myocarditis can affect the heart muscle and the heart’s electrical system, reducing the heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias).
Option D: Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. Restrictive cardiomyopathy (RCM) is a rare disease of the myocardium and is the least common of the three clinically recognized and described cardiomyopathies. It is characterized by diastolic dysfunction with restrictive ventricular physiology, whereas systolic function often remains normal. Atrial enlargement occurs due to impaired ventricular filling during diastole, but the volume and wall thickness of the ventricles are usually normal.

In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers – is apparent. Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease. It is defined by an increase in left ventricular wall thickness that is not solely explained by abnormal loading conditions. This disorder is caused by a mutation in cardiac sarcomere protein genes and is most frequently transmitted as an autosomal dominant trait.

Option A: In congestive cardiomyopathy, the heart becomes stretched and weakened and is unable to pump effectively. Congestive cardiomyopathy is a clinical state in which an abnormality of ventricular myocardium results in impaired pump function and circulatory congestion.
Option B: Dilated cardiomyopathy is also called congestive cardiomyopathy, which is a condition wherein the heart cannot pump effectively due to its weakening state. In dilated cardiomyopathy, the heart’s ability to pump blood is decreased because the heart’s main pumping chamber, the left ventricle, is enlarged, dilated and weak. At first, the chambers of the heart respond by stretching to hold more blood to pump through the body. This helps to strengthen the heart’s contraction and keep the blood moving for a short while. With time, the heart muscle walls weaken and are not able to pump as strongly.
Option D: Restrictive cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood.

Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. Heart failure can occur when the heart muscle is weak (systolic failure) or when it is stiff and unable to relax normally (diastolic failure). Cardiomyopathy, which means “disease of the heart muscle,” is one of many causes of heart failure.

Option B: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 1 and type 2 diabetic patients are at increased risk of cardiomyopathy and heart failure is a major cause of death for these patients. Cardiomyopathy in diabetes is associated with a cluster of features including decreased diastolic compliance, interstitial fibrosis, and myocyte hypertrophy.
Option C: Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries.
Option D: Pericardial effusion is most predominant in clients with pericarditis. Diabetes mellitus is unrelated to cardiomyopathy. Pericardial effusion puts pressure on the heart, affecting the heart’s function. If untreated, it can lead to heart failure or death.