Cardio - Path (Part 2: Hypertension, Hyperlipidemia, & Artery Disorders) Flashcards
Pg. 284-287 in First Aid 2014 Pg. 267-268 in First Aid 2013 Sections include: -Hypertension -Hyperlipidemia signs -Arteriosclerosis -Atherosclerosis -Aortic aneurysms -Aortic dissection
How is hypertension defined?
Defined as a systolic BP >= 140 mmHg and/or diastolic BP >= 90 mmHg
What are the risk factors for hypertension?
(1) Increased Age (2) Obesity (3) Diabetes (4) Smoking (5) Genetics (e.g., black > white > asian)
In terms of race, which have the greater risks for hypertension? List in order of decreasing risk.
Black > White > Asian
What percentage of hypertension is primary (essential)? What is the nature of the majority of the remaining hypertension?
90%; Remaining 10% mostly secondary to renal disease, including fibromuscular dysplasia in young patients
To what cardiovascular factors/changes is essential hypertension related?
Increased CO or Increased TPR
What defines a hypertensive emergency?
Hypertensive emergency - Severe hypertension (>= 180/120 mmHg) with evidence of acute, ongoing target organ damage (e.g., papilledema, mental status changes)
To what 7 conditions does hypertension predispose patients?
(1) Atherosclerosis (2) Left ventricular hypertrophy (3) Stroke (4) CHF (5) Renal failure (6) Retinopathy (7) Aortic dissection
What are 3 signs of hyperlipidemia?
(1) Xanthomas (2) Tendinous xanthoma (3) Corneal arcus
What are xanthomas? Where do they especially occur, and what are they called there?
Plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids (xanthelasma)
What is a Tendinous xanthoma? Where is it especially common?
Lipid deposit in tendon, especially Achilles
What is a Corneal arcus? What causes it to appear early in life? What is it called when it appears in the elderly?
Lipid deposit in cornea, appears early in life with hypercholesterolemia. Common in elderly (arcus senilus).
What are the types of Arteriosclerosis?
(1) Monckeberg (2) Arteriolosclerosis (3) Atherosclerosis
What is Monckeberg arteriosclerosis, and where is it especially found?
Calcification in the media of the arteries, especially radial or ulnar;
Is Monckeberg usually benign or malignant?
Benign
What is a key physical exam/imaging finding in Monckeberg arteriosclerosis?
“Pipestem” arteries
What are key histological findings Monckeberg arteriosclerosis? More specifically, what is the level of obstruction and/or vessel wall involvement?
Calcifications in media of the arteries, Does not obstruct blood flow; intima not involved
What are the types of arteriolosclerosis?
(1) Hyaline (2) Hyperplastic
What is hyaline arteriolosclerosis?
Thickening of small arteries in essential hypertension or diabetes mellitus
What is hyperplastic arteriolosclerosis?
“Onion skinning” in malignant hypertension
What is atherosclerosis?
Fibrous plaques and atheromas form in intima of arteries
What kind of arteries does atherosclerosis affect?
Disease of elastic arteries and large- and medium- sized muscular arteries
What are the modifiable risk factors for atherosclerosis? What are the non-modifiable risk factors for atherosclerosis?
MODIFIABLE: smoking, hypertension, hyperlipidemia, diabetes; NON-MODIFIABLE: age, gender (increase in men & postmenopausal women), & positive family history
What is important in the pathogenesis of atherosclerosis?
Inflammation
Describe the progression of atherosclerosis.
Endothelial cell dysfunction –> Macrophage and LDL accumulation –> Foam cell formation –> Fatty streaks –> Smooth muscle cell migration (involves PDGF & FGF), proliferation, & extracellular matrix deposition –> Fibrous plaque –> Complex atheromas
What are the complications associated with Atherosclerosis?
Aneurysms, ischemia, infarcts, peripheral vascular disease, thrombus, emboli
Name the prime locations of atherosclerosis in order of decreasing frequency.
Abdominal aorta > Coronary artery > Popliteal artery > Carotid artery
What are the symptoms associated with Atherosclerosis?
Angina, claudication, but can be asymptomatic
What are aortic aneurysms?
Localized pathologic dilation of blood vessel
What are the types of aortic aneurysms, and with what is each associated?
(1) Abdominal aortic aneurysm - Associated with atherosclerosis (2) Thoracic aortic aneurysm - Associated with hypertension, cystic medial necrosis (Marfan’s syndrome), & historically tertiary syphillis
In what patient population do abdominal aortic aneurysms occur more frequently?
Hypertensive male smokers > 50 years of age
What are the 3 conditions with which thoracic aortic aneurysms are associated?
Associated with cystic medial degeneration due to hypertension (older patients) or Marfan syndrome (younger patients). Also, historically associated with tertiary syphillis (obliterative endocarditis of the vasa vasorum).
What is an aortic dissection?
Longitudinal intraluminal tear forming a false lumen
With what conditions is an aortic dissection associated?
Associated with hypertension, bicuspid aortic valve, & inherited connective tissue disorders (e.g., Marfan’s syndrome)
How does aortic dissection present?
Presents with tearing chest pain radiating to the back +/- markedly unequal BP in arms
What is seen on chest x-ray for aortic dissection?
CXR shows mediastinal widening
What are the options for the extent of a false lumen in aortic dissection?
The false lumen can be limited to the ascending aorta, propagate from the ascending aorta, or propagate from the descending aorta
What can result from aortic dissection?
Pericardial tamponade, aortic rupture, death
What is a cause of hypertension in younger patients? How may it appear on vascular imaging?
“String of beads” appearance of the renal artery in fibromuscular dysplasia, a cause of hypertension in younger patients
What stain and histologic finding characterize hypertensive nephropathy?
Renal arterial hyalinosis on PAS stain
Is Monckeberg (medial calcific sclerosis) versus Arterioloslosclerosis common or uncommon?
MONCKEBERG: Uncommon; ARTERIOLOSCLEROSIS: Common
For what reasons may an aortic aneurysm cause pain?
May cause pain, which is a sign of leaking, dissection, or imminent rupture
