CVS Pathology 1: Hypertension

Question 1

Hypotension results in what?

Answer 1

Inadequate organ perfusion and can lead to tissue dysfunction or death.

Question 2

Hypertension results in what?

Answer 2

End-organ damage.

Question 3

Hypertension is a major risk factor for what?

Answer 3

Atherosclerosis, CHF, and renal failure.

Question 4

List the 2 types of hypertension?

Answer 4

1- essential hypertension.
2- secondary hypertension.

Question 5

List the factors that influence essential hypertension?

Answer 5

1- genetic influences.
2- environmental factors.

Question 6

List the 3 genetic influences of essential hypertension?

Answer 6

1- defects in renal sodium hemostasis.
2- functional vasoconstriction.
3- defects in vascular smooth muscle growth and structure.

Question 7

list 5 complications of hypertension?

Answer 7

1- increase atherosclerotic risk.
2- cardiac hypertrophy and heart failure.
3- multi-infract dementia.
4- aortic dissection.
5- renal failure.

Question 8

Left untreated, half of hypertensive patients die of what? And another third die of what?

Answer 8

Half die of ischemic heart disease (IHD) or congestive heart failure (CHD), and another die of stroke.

Question 9

Hypertension is associated with which 2 forms of small blood vessel disease?

Answer 9

1- hyaline arteriosclerosis.
2- hyperplastic arteriosclerosis.

Question 10

Hyaline arteriosclerosis’ lesion consists of what?

Answer 10

Consists of a homogeneous pink hyaline thickening of the walls of arterioles with narrowing of the lumen.

Question 11

Hyaline arteriolosclerosis lesion reflects what?

Answer 11

1- leakage of plasma components.
2- excessive (extra-cellular matrix) ECM production by (smooth muscle cells) SMCs.

Question 12

Which type of arteriolosclerosis is associated with “onion-skin” concentric laminated thickening of the walls of arterioles with luminal narrowing?

Answer 12

Hyperplastic arteriolosclerosis.

Question 13

The laminations of hyperplastic arteriolosclerosis consist of what?

Answer 13

SMCs and thickened, duplicated basement membrane.

Question 14

In malignant hypertension what changes accompany hyperplastic arteriolosclerosis?

Answer 14

Fibrinoid deposits and vessel wall necrosis.

Question 15

Hypertension-associated degenerative changes in the walls of large and medium arteries can result in what? (3)

Answer 15

1- accelerating atherogenesis.
2- aortic dissection.
3- cerebrovascular hemorrhage.

Question 16

How is systemic (left-sided) hypertensive heart disease diagnosed?

Answer 16

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).

Question 17

Compensated hypertensive heart disease may be __________ (symptomatic, asymptomatic)?

Answer 17

Asymptomatic.

Question 18

Compensated hypertensive heart disease may come to attention only after onset of ________ _____ or/and ______.

Answer 18

After onset of atrial fibrillation or/and CHF.

Question 19

Patients with compensated hypertensive heart disease may …? (4)

Answer 19

1– enjoy a normal life.
2- develop progressive IHD.
3- experience progressive HF.
4- suffer progressive renal damage or cerebrovascular stroke.

Question 20

The essential feature of hypertensive heart disease is which macroscopic morphology?

Answer 20

Left ventricular hypertrophy.

Question 21

In time the increased thickness of the left ventricular wall imparts which macroscopic morphology?

Answer 21

Imparts a stiffness that impairs diastolic filling, frequently with consequent left atrial enlargement.

Question 22

The earliest change of systemic HHD (hypertensive heart disease) is which microscopic morphology?

Answer 22

Increase in the transverse diameter of myocytes.

Question 23

At a more advanced stage which microscopic morphology becomes apparent?

Answer 23

At a more advance stage variable degree of cellular and nuclear enlargement become apparent, often accompanied by interstitial fibrosis.

Question 24

Definition: term used for the renal pathology associated with sclerosis of renal arterioles and small arteries?

Answer 24

Benign nephrosclerosis.

Question 25

Benign nephrosclerosis is strongly associate with which disease?

Answer 25

Hypertension, which can be both a cause and a consequence of nephrosclerosis.

Question 26

Benign nephrosclerosis is more frequent in which race group?

Answer 26

Blacks.

Question 27

Which chronic illnesses increase the incidence and severity of benign nephrosclerosis lesions?

Answer 27

Hypertension and diabetes mellitus.

Question 28

It is unusual for uncomplicated nephrosclerosis to cause what?

Answer 28

Renal insufficiency or uremia.

Question 29

Three groups of hypertensive patients with nephrosclerosis are at risk of developing renal failure?

Answer 29

1- people of African descent.
2- people with severe blood pressure elevations.
3- persons with a second underlying disease, especially diabetes.

Question 30

List the 2 processes that participate in the arterial lesions of nephrosclerosis?

Answer 30

1- medial and intimal thickening.
2- hyalinization of arteriolar walls.

Question 31

Medial and intimal thickening happens as a response to what?

Answer 31

As a response to hemodynamic changes, aging, genetic defects, or some combination of these.

Question 32

Hyalinization of arteriolar walls are caused by what?

Answer 32

Caused by extravasation of plasma proteins through injured endothelium and by increased deposition of basement membrane matrix.

Question 33

What is the macroscopic morphology of benign nephrosclerosis?

Answer 33

The kidneys are symmetrically atrophic with a surface of diffuse, fine granularity.

Question 34

The loss of mass in benign nephrosclerosis is due to what?

Answer 34

Due mainly to cortical scarring and shrinking.

Question 35

What is the microscopic morphology of benign nephrosclerosis?

Answer 35

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.

Question 36

Consequent to the vascular narrowing, there is patchy ischemic atrophy, which consists of what?

Answer 36

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).

Question 37

Definition: a rapidly rising blood pressure that, if untreated, leads to death within 1 to 2 years.

Answer 37

Malignant hypertension.

Question 38

The full blown syndrome of malignant hypertension is characterized by what? (6)

Answer 38

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.

Question 39

Malignant hypertension can develop in previously normotensive persons but is more often superimposed on which condition?

Answer 39

Preexisting “benign” hypertension

Question 40

At onset, malignant hypertension may only show ______ and ___________, but ____________ soon ensues.

Answer 40

A marked proteinuria and microscopic or macroscopic hematuria, but renal failure soon ensues.

Question 41

Definition: a renal vascular disorder associated with malignant or accelerated hypertension?

Answer 41

Malignant nephrosclerosis.

Question 42

Malignant nephrosclerosis in its pure form ususally affects which age group?

Answer 42

Younger individuals.

Question 43

Malignant nephrosclerosis more often affects which race and gender?

Answer 43

More often in men and in blacks.

Question 44

The fundamental lesion in malignant nephrosclerosis is what?

Answer 44

Vascular injury.

Question 45

The vascular injury in malignant hypertension commonly results from what?

Answer 45

Results from long-standing benign hypertension, arteritis, or a coagulopathy, alone or in combination.

Question 46

The vascular damage in malignant nephrosclerosis causes what?

Answer 46

1- increase permeability of the small vessels to fibrinogen and other plasma proteins.
2- endothelial injury.
3- platelet deposition.

Question 47

Vascular damage due to malignant nephrosclerosis leads to the appearance of what?

Answer 47

1- fibrinoid necrosis of arterioles and small arteries.
2- intravascular thrombosis.

Question 48

What is the pathogenesis of malignant nephrosclerosis?

Answer 48

Growth factors from platelets and plasma > intimal smooth muscle cell hyperplasia (hyperplastic arteriolosclerosis) > further narrowing of the lumina.
Thus the kidneys become markedly ischemic.

Question 49

What happens in malignant nephrosclerosis with severe involvement of the renal afferent arterioles?

Answer 49

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.

Question 50

The kidney sized in malignant nephrosclerosis varies in macroscopic pathology based on what?

Answer 50

The duration and severity of the hypertensive disease.

Question 51

What is the macroscopic morphology of malignant nephrosclerosis?

Answer 51

Small, pinpoint petechial hemorrhages may appear on the cortical surface from rupture of arterioles or glomerular capillaries.

Question 52

Which disease gives the kidneys a “flea-bitten” appearance?

Answer 52

Malignant nephrosclerosis.

Question 53

Which 2 histologic alteration characterize blood vessels in malignant hypertension?

Answer 53

1- fibrinoid necrosis of arterioles.
2- hyperplastic arteriolitis.

Question 54

What does the lesion in malignant nephrosclerosis cause?

Answer 54

Causes marked narrowing of arterioles and small arteries.

Question 55

In malignant hypertension necrosis may involve what?

Answer 55

May involve glomeruli, with microthrombi within the glomeruli as well as necrotic arterioles.