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

1
Q

How is hypertension defined?

A

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

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2
Q

What are the risk factors for hypertension?

A

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

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3
Q

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

A

Black > White > Asian

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4
Q

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

A

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

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5
Q

To what cardiovascular factors/changes is essential hypertension related?

A

Increased CO or Increased TPR

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6
Q

What defines a hypertensive emergency?

A

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

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7
Q

To what 7 conditions does hypertension predispose patients?

A

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

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8
Q

What are 3 signs of hyperlipidemia?

A

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

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9
Q

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

A

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

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10
Q

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

A

Lipid deposit in tendon, especially Achilles

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11
Q

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

A

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

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12
Q

What are the types of Arteriosclerosis?

A

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

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13
Q

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

A

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

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14
Q

Is Monckeberg usually benign or malignant?

A

Benign

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15
Q

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

A

“Pipestem” arteries

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16
Q

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

A

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

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17
Q

What are the types of arteriolosclerosis?

A

(1) Hyaline (2) Hyperplastic

18
Q

What is hyaline arteriolosclerosis?

A

Thickening of small arteries in essential hypertension or diabetes mellitus

19
Q

What is hyperplastic arteriolosclerosis?

A

“Onion skinning” in malignant hypertension

20
Q

What is atherosclerosis?

A

Fibrous plaques and atheromas form in intima of arteries

21
Q

What kind of arteries does atherosclerosis affect?

A

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

22
Q

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

A

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

23
Q

What is important in the pathogenesis of atherosclerosis?

A

Inflammation

24
Q

Describe the progression of atherosclerosis.

A

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

25
What are the complications associated with Atherosclerosis?
Aneurysms, ischemia, infarcts, peripheral vascular disease, thrombus, emboli
26
Name the prime locations of atherosclerosis in order of decreasing frequency.
Abdominal aorta > Coronary artery > Popliteal artery > Carotid artery
27
What are the symptoms associated with Atherosclerosis?
Angina, claudication, but can be asymptomatic
28
What are aortic aneurysms?
Localized pathologic dilation of blood vessel
29
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
30
In what patient population do abdominal aortic aneurysms occur more frequently?
Hypertensive male smokers > 50 years of age
31
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).
32
What is an aortic dissection?
Longitudinal intraluminal tear forming a false lumen
33
With what conditions is an aortic dissection associated?
Associated with hypertension, bicuspid aortic valve, & inherited connective tissue disorders (e.g., Marfan's syndrome)
34
How does aortic dissection present?
Presents with tearing chest pain radiating to the back +/- markedly unequal BP in arms
35
What is seen on chest x-ray for aortic dissection?
CXR shows mediastinal widening
36
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
37
What can result from aortic dissection?
Pericardial tamponade, aortic rupture, death
38
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
39
What stain and histologic finding characterize hypertensive nephropathy?
Renal arterial hyalinosis on PAS stain
40
Is Monckeberg (medial calcific sclerosis) versus Arterioloslosclerosis common or uncommon?
MONCKEBERG: Uncommon; ARTERIOLOSCLEROSIS: Common
41
For what reasons may an aortic aneurysm cause pain?
May cause pain, which is a sign of leaking, dissection, or imminent rupture