3D - Path of Hypertension, Arteriosclerosis, and Aneurisms

Question 1

What is hypertension?

Answer 1

Chronic elevation of systemic arterial blood pressure (MAP)

Question 2

Why is hypertension deadly?

• Detection?
• Symptoms?
• Effect on arterial vessels?

Answer 2

1. Not easily detected - silent disease
2. Typically asymptomatic and diagnosis is by chance screening or other medical care
3. Stimulates arterial vessels to thicken and strengthen, losing elasticity
4. Damages delicate capillaries of eyes and kidneys

Question 3

How does hypertension affect arterial vessels?

Answer 3

Stimulates arterial vessels to thicken and strengthen

- This lowers elasticity and ability to change diameter

Question 4

Where in the body are capillaries especially thin and delicate?
- Especially sensitive to hypertension

Answer 4

Capillaries of the eye and kidneys

Question 5

Does hypertension increase or decrease afterload?

Answer 5

It substantially increases afterload, increasing the heart’s workload
- Leads to myocardial hypertrophy

Question 6

Hypertension is a major risk factor for:

Answer 6

1. Stroke
2. Myocardial infarction
3. Heart failure
4. Aneurysms
5. Peripheral artery disease
6. Chronic kidney disease

Question 7

What are the two types of hypertension?

Answer 7

1. Primary (Essential) Hypertension - 90-95%
   - Chronic elevation of BP that occurs without underlying disease (age, race, family, gender, smoking, alcohol, salt intake, stress, sedentary)
2. Secondary Hypertension
   - Caused by a disorder/situation that increases TPR or CO
   - Renal failure (most common)
   - Renin-producing tumors, Cushing’s, hyperaldosteronism, pheochromocytoma

Question 8

Arteriosclerosis

• What is being thickened and hardened?
• Which layers especially?

Answer 8

Abnormal thickening and hardening of the arterial walls (especially tunica intima and media)

Decreases ability of an artery to change its radius, mainly due to increased rigidity and loss of elasticity (typically noticed during exercise - abnormal pain in legs due to ishemia)

Question 9

How does arteriosclerosis lead to ischemia?

Answer 9

Arteriosclerosis can lead to narrowing of the arterial lumen - restricting blood flow

Question 10

What are two conditions that arteriosclerosis is associated with?

Answer 10

Hypertension and diabetes mellitus

Question 11

What are vessel aneurysms?

Answer 11

Weakening of the vessel wall, followed by abnormal dilations, which have a tendency to rupture

Question 12

Are vessel aneurysms symptomatic or asymptomatic?

Answer 12

Typically asymptomatic, unless there is compression of neighboring structures (nerves, tissue)

Question 13

What is the cause of aneurysms?

Answer 13

They can be congenital or acquired (the vessel wall weakened for some reason)

Question 14

Are all aneurysms repairable?

Answer 14

Not all - it depends on the location

• Aneurysms of vessels deep in the brain are hard to reach
• Largest risk is for the aneurysm to rupture

Question 15

Describe a circumferential or fusiform aneurysm

• How much of the artery wall affected?
• Common where?
• Symptomatic?

Answer 15

The entire wall of the artery outpouches

Common in the abdominal aorta - AAA - abdominal aortic aneurysm

Can be symptomatic - ex. AAA has no nearby tissues to compress against

Question 16

Describe a saccular or berry aneurysm

• How much of the artery wall affected?
• Common where?
• Symptomatic?

Answer 16

Only one portion of the arterial wall outpouches

Most often observed in the small arteries of the brain - especially the Circle of Willis

Can be symptomatic - ex. if affecting nerves near Circle of Willis

Question 17

Describe a dissecting aneurysm

• Similar to what other aneurysm
• How is the artery affected?
• Common where?
• Symptomatic or asymptomatic?

Answer 17

Similar to circumferential

Tunics of the arterial wall separate - blood collects in-between the tunics

Common in the aortic arch (symptomatic)