Cardio - Path (Part 2: Hypertension, Hyperlipidemia, & Artery Disorders)

Question 1

How is hypertension defined?

Answer 1

Defined as a systolic BP >= 140 mmHg and/or diastolic BP >= 90 mmHg

Question 2

What are the risk factors for hypertension?

Answer 2

(1) Increased Age (2) Obesity (3) Diabetes (4) Smoking (5) Genetics (e.g., black > white > asian)

Question 3

In terms of race, which have the greater risks for hypertension? List in order of decreasing risk.

Answer 3

Black > White > Asian

Question 4

What percentage of hypertension is primary (essential)? What is the nature of the majority of the remaining hypertension?

Answer 4

90%; Remaining 10% mostly secondary to renal disease, including fibromuscular dysplasia in young patients

Question 5

To what cardiovascular factors/changes is essential hypertension related?

Answer 5

Increased CO or Increased TPR

Question 6

What defines a hypertensive emergency?

Answer 6

Hypertensive emergency - Severe hypertension (>= 180/120 mmHg) with evidence of acute, ongoing target organ damage (e.g., papilledema, mental status changes)

Question 7

To what 7 conditions does hypertension predispose patients?

Answer 7

(1) Atherosclerosis (2) Left ventricular hypertrophy (3) Stroke (4) CHF (5) Renal failure (6) Retinopathy (7) Aortic dissection

Question 8

What are 3 signs of hyperlipidemia?

Answer 8

(1) Xanthomas (2) Tendinous xanthoma (3) Corneal arcus

Question 9

What are xanthomas? Where do they especially occur, and what are they called there?

Answer 9

Plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids (xanthelasma)

Question 10

What is a Tendinous xanthoma? Where is it especially common?

Answer 10

Lipid deposit in tendon, especially Achilles

Question 11

What is a Corneal arcus? What causes it to appear early in life? What is it called when it appears in the elderly?

Answer 11

Lipid deposit in cornea, appears early in life with hypercholesterolemia. Common in elderly (arcus senilus).

Question 12

What are the types of Arteriosclerosis?

Answer 12

(1) Monckeberg (2) Arteriolosclerosis (3) Atherosclerosis

Question 13

What is Monckeberg arteriosclerosis, and where is it especially found?

Answer 13

Calcification in the media of the arteries, especially radial or ulnar;

Question 14

Is Monckeberg usually benign or malignant?

Answer 14

Benign

Question 15

What is a key physical exam/imaging finding in Monckeberg arteriosclerosis?

Answer 15

“Pipestem” arteries

Question 16

What are key histological findings Monckeberg arteriosclerosis? More specifically, what is the level of obstruction and/or vessel wall involvement?

Answer 16

Calcifications in media of the arteries, Does not obstruct blood flow; intima not involved

Question 17

What are the types of arteriolosclerosis?

Answer 17

(1) Hyaline (2) Hyperplastic

Question 18

What is hyaline arteriolosclerosis?

Answer 18

Thickening of small arteries in essential hypertension or diabetes mellitus

Question 19

What is hyperplastic arteriolosclerosis?

Answer 19

“Onion skinning” in malignant hypertension

Question 20

What is atherosclerosis?

Answer 20

Fibrous plaques and atheromas form in intima of arteries

Question 21

What kind of arteries does atherosclerosis affect?

Answer 21

Disease of elastic arteries and large- and medium- sized muscular arteries

Question 22

What are the modifiable risk factors for atherosclerosis? What are the non-modifiable risk factors for atherosclerosis?

Answer 22

MODIFIABLE: smoking, hypertension, hyperlipidemia, diabetes; NON-MODIFIABLE: age, gender (increase in men & postmenopausal women), & positive family history

Question 23

What is important in the pathogenesis of atherosclerosis?

Answer 23

Inflammation

Question 24

Describe the progression of atherosclerosis.

Answer 24

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

Question 25

What are the complications associated with Atherosclerosis?

Answer 25

Aneurysms, ischemia, infarcts, peripheral vascular disease, thrombus, emboli

Question 26

Name the prime locations of atherosclerosis in order of decreasing frequency.

Answer 26

Abdominal aorta > Coronary artery > Popliteal artery > Carotid artery

Question 27

What are the symptoms associated with Atherosclerosis?

Answer 27

Angina, claudication, but can be asymptomatic

Question 28

What are aortic aneurysms?

Answer 28

Localized pathologic dilation of blood vessel

Question 29

What are the types of aortic aneurysms, and with what is each associated?

Answer 29

(1) Abdominal aortic aneurysm - Associated with atherosclerosis (2) Thoracic aortic aneurysm - Associated with hypertension, cystic medial necrosis (Marfan’s syndrome), & historically tertiary syphillis

Question 30

In what patient population do abdominal aortic aneurysms occur more frequently?

Answer 30

Hypertensive male smokers > 50 years of age

Question 31

What are the 3 conditions with which thoracic aortic aneurysms are associated?

Answer 31

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).

Question 32

What is an aortic dissection?

Answer 32

Longitudinal intraluminal tear forming a false lumen

Question 33

With what conditions is an aortic dissection associated?

Answer 33

Associated with hypertension, bicuspid aortic valve, & inherited connective tissue disorders (e.g., Marfan’s syndrome)

Question 34

How does aortic dissection present?

Answer 34

Presents with tearing chest pain radiating to the back +/- markedly unequal BP in arms

Question 35

What is seen on chest x-ray for aortic dissection?

Answer 35

CXR shows mediastinal widening

Question 36

What are the options for the extent of a false lumen in aortic dissection?

Answer 36

The false lumen can be limited to the ascending aorta, propagate from the ascending aorta, or propagate from the descending aorta

Question 37

What can result from aortic dissection?

Answer 37

Pericardial tamponade, aortic rupture, death

Question 38

What is a cause of hypertension in younger patients? How may it appear on vascular imaging?

Answer 38

“String of beads” appearance of the renal artery in fibromuscular dysplasia, a cause of hypertension in younger patients

Question 39

What stain and histologic finding characterize hypertensive nephropathy?

Answer 39

Renal arterial hyalinosis on PAS stain

Question 40

Is Monckeberg (medial calcific sclerosis) versus Arterioloslosclerosis common or uncommon?

Answer 40

MONCKEBERG: Uncommon; ARTERIOLOSCLEROSIS: Common

Question 41

For what reasons may an aortic aneurysm cause pain?

Answer 41

May cause pain, which is a sign of leaking, dissection, or imminent rupture