CVS Pathology 1: Hypertension Flashcards
Hypotension results in what?
Inadequate organ perfusion and can lead to tissue dysfunction or death.
Hypertension results in what?
End-organ damage.
Hypertension is a major risk factor for what?
Atherosclerosis, CHF, and renal failure.
List the 2 types of hypertension?
1- essential hypertension.
2- secondary hypertension.
List the factors that influence essential hypertension?
1- genetic influences.
2- environmental factors.
List the 3 genetic influences of essential hypertension?
1- defects in renal sodium hemostasis.
2- functional vasoconstriction.
3- defects in vascular smooth muscle growth and structure.
list 5 complications of hypertension?
1- increase atherosclerotic risk.
2- cardiac hypertrophy and heart failure.
3- multi-infract dementia.
4- aortic dissection.
5- renal failure.
Left untreated, half of hypertensive patients die of what? And another third die of what?
Half die of ischemic heart disease (IHD) or congestive heart failure (CHD), and another die of stroke.
Hypertension is associated with which 2 forms of small blood vessel disease?
1- hyaline arteriosclerosis.
2- hyperplastic arteriosclerosis.
Hyaline arteriosclerosis’ lesion consists of what?
Consists of a homogeneous pink hyaline thickening of the walls of arterioles with narrowing of the lumen.
Hyaline arteriolosclerosis lesion reflects what?
1- leakage of plasma components.
2- excessive (extra-cellular matrix) ECM production by (smooth muscle cells) SMCs.
Which type of arteriolosclerosis is associated with “onion-skin” concentric laminated thickening of the walls of arterioles with luminal narrowing?
Hyperplastic arteriolosclerosis.
The laminations of hyperplastic arteriolosclerosis consist of what?
SMCs and thickened, duplicated basement membrane.
In malignant hypertension what changes accompany hyperplastic arteriolosclerosis?
Fibrinoid deposits and vessel wall necrosis.
Hypertension-associated degenerative changes in the walls of large and medium arteries can result in what? (3)
1- accelerating atherogenesis.
2- aortic dissection.
3- cerebrovascular hemorrhage.
How is systemic (left-sided) hypertensive heart disease diagnosed?
1- left ventricular hypertrophy (usually concentric) in the absence of other cardiovascular pathology.
2- a clinical history or pathologic evidence of hypertension in other organs (e.g. kidney).
Compensated hypertensive heart disease may be __________ (symptomatic, asymptomatic)?
Asymptomatic.
Compensated hypertensive heart disease may come to attention only after onset of ________ _____ or/and ______.
After onset of atrial fibrillation or/and CHF.
Patients with compensated hypertensive heart disease may …? (4)
1– enjoy a normal life.
2- develop progressive IHD.
3- experience progressive HF.
4- suffer progressive renal damage or cerebrovascular stroke.
The essential feature of hypertensive heart disease is which macroscopic morphology?
Left ventricular hypertrophy.
In time the increased thickness of the left ventricular wall imparts which macroscopic morphology?
Imparts a stiffness that impairs diastolic filling, frequently with consequent left atrial enlargement.
The earliest change of systemic HHD (hypertensive heart disease) is which microscopic morphology?
Increase in the transverse diameter of myocytes.
At a more advanced stage which microscopic morphology becomes apparent?
At a more advance stage variable degree of cellular and nuclear enlargement become apparent, often accompanied by interstitial fibrosis.
Definition: term used for the renal pathology associated with sclerosis of renal arterioles and small arteries?
Benign nephrosclerosis.
Benign nephrosclerosis is strongly associate with which disease?
Hypertension, which can be both a cause and a consequence of nephrosclerosis.
Benign nephrosclerosis is more frequent in which race group?
Blacks.
Which chronic illnesses increase the incidence and severity of benign nephrosclerosis lesions?
Hypertension and diabetes mellitus.
It is unusual for uncomplicated nephrosclerosis to cause what?
Renal insufficiency or uremia.
Three groups of hypertensive patients with nephrosclerosis are at risk of developing renal failure?
1- people of African descent.
2- people with severe blood pressure elevations.
3- persons with a second underlying disease, especially diabetes.
List the 2 processes that participate in the arterial lesions of nephrosclerosis?
1- medial and intimal thickening.
2- hyalinization of arteriolar walls.
Medial and intimal thickening happens as a response to what?
As a response to hemodynamic changes, aging, genetic defects, or some combination of these.
Hyalinization of arteriolar walls are caused by what?
Caused by extravasation of plasma proteins through injured endothelium and by increased deposition of basement membrane matrix.
What is the macroscopic morphology of benign nephrosclerosis?
The kidneys are symmetrically atrophic with a surface of diffuse, fine granularity.
The loss of mass in benign nephrosclerosis is due to what?
Due mainly to cortical scarring and shrinking.
What is the microscopic morphology of benign nephrosclerosis?
1- hyaline arteriolosclerosis and fibroelastic hyperplasia.
2- subcapsular scars with sclerotic glomeruli and tubular dropout alternating with better preserve parenchyma (corresponding to the finely granular surface).
3- patchy ischemic atrophy.
Consequent to the vascular narrowing, there is patchy ischemic atrophy, which consists of what?
1- foci of tubular atrophy and interstitial fibrosis.
2- a variety of glomerular alterations (include collapse of the GBM, deposition of collagen within bowman space, periglomerular fibrosis, and total sclerosis of glomeruli).
Definition: a rapidly rising blood pressure that, if untreated, leads to death within 1 to 2 years.
Malignant hypertension.
The full blown syndrome of malignant hypertension is characterized by what? (6)
1- encephalopathy.
2- papilledema.
3- retinal hemorrhages.
4- systolic pressure greater than 200 mmHg and diastolic pressures greater than 120 mmHg.
5- cardiovascular abnormalities.
6- renal failure.
Malignant hypertension can develop in previously normotensive persons but is more often superimposed on which condition?
Preexisting “benign” hypertension
At onset, malignant hypertension may only show ______ and ___________, but ____________ soon ensues.
A marked proteinuria and microscopic or macroscopic hematuria, but renal failure soon ensues.
Definition: a renal vascular disorder associated with malignant or accelerated hypertension?
Malignant nephrosclerosis.
Malignant nephrosclerosis in its pure form ususally affects which age group?
Younger individuals.
Malignant nephrosclerosis more often affects which race and gender?
More often in men and in blacks.
The fundamental lesion in malignant nephrosclerosis is what?
Vascular injury.
The vascular injury in malignant hypertension commonly results from what?
Results from long-standing benign hypertension, arteritis, or a coagulopathy, alone or in combination.
The vascular damage in malignant nephrosclerosis causes what?
1- increase permeability of the small vessels to fibrinogen and other plasma proteins.
2- endothelial injury.
3- platelet deposition.
Vascular damage due to malignant nephrosclerosis leads to the appearance of what?
1- fibrinoid necrosis of arterioles and small arteries.
2- intravascular thrombosis.
What is the pathogenesis of malignant nephrosclerosis?
Growth factors from platelets and plasma > intimal smooth muscle cell hyperplasia (hyperplastic arteriolosclerosis) > further narrowing of the lumina.
Thus the kidneys become markedly ischemic.
What happens in malignant nephrosclerosis with severe involvement of the renal afferent arterioles?
The renin-angiotensin system receives a powerful stimulus.
This leads to the synthesis of angiotensin 2 which causes vasoconstriction.
This then sets up a self-perpetuating cycle.
Aldosterone levels are also elevated, and salt retention contributes to the elevation of blood pressure.
The kidney sized in malignant nephrosclerosis varies in macroscopic pathology based on what?
The duration and severity of the hypertensive disease.
What is the macroscopic morphology of malignant nephrosclerosis?
Small, pinpoint petechial hemorrhages may appear on the cortical surface from rupture of arterioles or glomerular capillaries.
Which disease gives the kidneys a “flea-bitten” appearance?
Malignant nephrosclerosis.
Which 2 histologic alteration characterize blood vessels in malignant hypertension?
1- fibrinoid necrosis of arterioles.
2- hyperplastic arteriolitis.
What does the lesion in malignant nephrosclerosis cause?
Causes marked narrowing of arterioles and small arteries.
In malignant hypertension necrosis may involve what?
May involve glomeruli, with microthrombi within the glomeruli as well as necrotic arterioles.
