HTN Flashcards
بسم الله ربنا عليك توكلنا وإليك وأنبنا وإليك المصير
بارك لنا ربنا فيما أعطيت وأجعل لنا في أوقاتنا وعقولنا وأفهامنا وأسماعنا وأبصارنا البركة ما أحييتنا انت مولانا
Definition of HTN .
It is progressive elevation of sustained elevated blood pressure >140/90 with thikening of the arterioles
Mention primary HTN theories ,
Essential HTN is idiopathic and represents 95% of cases may due to : 5s
1-stress increasing Sympahathic stimulation and vc in the long run Muscle proliferation occurs casuing vc of vessel
2-salt intolerance the kideny is powerful in reabposption of na and water increaing blood volume and cop and abp
3-Sensitivity to angiotenisn 2 due to increased receptors it is the most potent vasoconstrictor in the body
4-secretion of aldosternoe with abnormal metabolism
5-smoking
Mention caused of 2ry HTN .
NERVE ! عصب
N:eurogenic increaed intracranial pressure
E:ndocranial conns cushing and pheochrmomcytoma
Renal reinin increases in nephritis and congential and vascular diseas and Tumors
Vascular : Aortic coarcatatrion and plycythemia AV SHUNT
Eclampsia and preeclampsia renal pregnancy HTN
Grades of HTN
:
mild 140-159/90-99
moderate 160-179/100-109
svere 180-199 / 110-119
vere severe >210/120
Benign HTN
is HTN usually primamry gradual onset long duaraiton in elderly >50years less than 200/100?
Effect of Bening HTN of arterioles mention .
Leads to stimulation of fibroblast to increase deposition of elaastic fibers called Elastosis alot of elastic fibers collect together and are compressed casuing homogenous pink apperarncae called Hyalinosis and this reuslt in Narrowing of the lumen and thickness of the wall leading to increased The BP more entering into a Viscous cycle .
so Microscopic: Elastosis and Hyalinosis
So Gross : narrwowing lumen thickness of the wall
Microscopic: of benign htn Arterioles
Elastosis and Hyalinosis
Gross of Bening HTN ? arterioells
Gross : narrwowing lumen thickness of the wall
What occurs to kideny in Benign HTN ?
The renal arteriole witnesses Elastosis and Hyalinosis and decreasfd kifeny supply casuing Atrophy of the glomeruli and its tubules and some of them has compensatory dilatation response .
the atrophied places may witness fibrosis
Microscopic : Atrophy + Fibrosis in kideny
arterioles : elastosis + Hyalinosis
so the kidney grossly may show: Contracted kideny
Decrease in size bilateral\
firm Granular appearance and pale color due to fibrosis reteaction
multiple cysts due to compensatroty tubular dilatation
No demarcation between cortex and medulla
caspule is adherent and dry
perinephric fat is increased!
What are effect of benign HTN on the arteries ?
Atherosclerosis and it complications like aortic aneryusm
Kideny in benign HTN MICROSCOPIC nephrosclerosis
Microscopic : Atrophy + Fibrosis in kideny
arterioles : elastosis + Hyalinosis
the kidney grossly may show:? in benign HTN ?
nephrosclerosis
the kidney grossly may show: Contracted kideny
Decrease in size bilateral\
firm Granular appearance and pale color due to fibrosis reteaction
multiple cysts due to compensatroty tubular dilatation
No demarcation between cortex and medulla
caspule is adherent and dry
perinephric fat is increased!
TIP STROKE MEAN
نوبات اغماء مفاجئ بسبب نزيف في المخ
Mention effect of the Bening HTN on the Heart
Increased Blood pressure leads to increased afterload againST Heart
and this leads to left ventricular Hypertrophy and Dystolic dysfucntion and ischemia and may precipitate Heart failure conestive !
Mention effect of the Bening HTN on brain
May casue charcot or cereberal micro anyrusm in the small vessels in brain and its repture csauing hemorhage casuing stroke !
شلل أطراف
شلل كلام
تقل الخحركة
مشاكل الاحساس
Also in malignant HTN
Mention effect of the Bening HTN on EYES ?
The artrioles elastosis and hyalinosis
so they are rigid and wall is thickened compressing veins casuing congestion leading to papilledema and problems in sight and may cause detachment or retina or hemohhrage blindness
also in Malignant HTN
Describe Malignant HTN >
It is more severe and usually 2ry Of sudden onset and short dureation fatal and appear in young age <30 years > 280/180
(أَقِيمُوا الصُّفُوفَ ، وَحَاذُوا بَيْنَ الْمَنَاكِبِ ، وَسُدُّوا الْخَلَلَ ، وَلِينُوا بِأَيْدِي إِخْوَانِكُمْ ، وَلَا تَذَرُوا فُرُجَاتٍ لِلشَّيْطَانِ ، وَمَنْ وَصَلَ صَفًّا وَصَلَهُ اللَّهُ ، وَمَنْ قَطَعَ صَفًّا قَطَعَهُ اللَّهُ
ارفع صوتك بالنداء عاليا!
فلتكن فيك قوة !
describe morphological change in arteioles in malignant HTN
It beigns with stimlation of fibroblast and Elastosis and Hyalinosis Then there is proliferaiton of smooth muscle fibers and basement membrane(onion skin)
hyperplastic arteriolsclerosis,
casugin severe narrowing of the lumen causing broken collagen (fibrinoid necrosis ) and cracks in the wall of blood vessel and extension of cracks in the wall and permeability of plasma protein(FIBRIN) into the wall of blood vessel AND there is transmural crack into the wall casuing hemorrhage
type on necrosis in malignant HTN in artrioles ?
Fibrnioid necrosis
Arterioles:
Gross:
maglinant HTN
(onion skin)
very thick wall
multiple layers
Microscopic of arterioles in Malignant HTN Describe.
Microscopic: Elastosis + Hyalinosis -Hyperplasia of S.M. & basement membrane -Fibrinoid necrosis + permeation of plasma proteins in the wall -Ruptured vessels
Controller Medications of asthma mention .
✓ Inhaled glucocorticosteroids ✓ Leukotriene modifiers ✓ LABA+ICS combination ✓ Systemic glucocorticosteroids ✓ Anti-IgE & Anti-IL4,5 (biological thearpy)
Malignant HTN and Arteries
Arteries: Atherosclerosis & its
complications
with aortic dissection
Malignant nephrosclerosis
Gross describe
Red spots (flea –bitten) focal necrosis
Malignant HTN and Kideny in microscopic appearance
artrioles : elastosis and hylainosis + Smooth muscle proliferation and BM and fibrinoid necrosis +permeation of plasma proteins and ruptured blood vessel .
Tubules and glomeruli : hemorrhage .
Malignant HTN and effects on the kidny ?
The arterioles are damaged as we said before and there is hemorrhage in the glomeruli and tubules and kidney is stopped and there is focal necrosis and flea bitten with its normal size due to sudden onset and smooth surface and easily detached capsule due to no fibrosis
easily demarcation between the cortex and medulla
Left ventricular hypertrophy is
minimal in malignant HTN ?
due to suddent onset of action
Benign &Malignant HTN their common complications are?
- Arteries atherosclerosis
- Cerebral Hemorrhage
- Retinal damage papilledema
Causes of death in Bennign HTN?
1-Congestive Heart failure
2-IHD
3-Cerebral hemorrhage
4-Renal Failure
Causes of death in Malignant HTN?
1-Renal failure MAIN
2-IHD and Heart failure
3-Cerebral hemorrhgae
Discuss : Effect of hypertension on the Heart?
- afterload (pressure overload), leading to
ventricular hypertrophy→ relative ischemia → diastolic
dysfunction - atheroscleros→ myocardial infarction
- Heart failure.
“كتاب أنزل إليك فلا يكن في صدرك حرج منه لتنذر به وذكري للمؤمنين”
الحمدلله رب العالمين
