Hypertension and atherosclerosis

Question 1

Why does cardiac hypertrophy occur?

Answer 1

In response to pressure overload

Question 2

What happens in response to cardiac hypertrophy, 4 steps

Answer 2

Myocardial dysfunction due to insufficient coronary blood supply

Leads to cardiac dilation

This causes congestive heart failure and sudden death

Question 3

Microscopically, what will you see when there is hypertrophy?

Answer 3

Pinker fibers due to more mitochondria, boxcar nuclei, fibrosis

Question 4

In systemic HTN how does the heart change and what affect does this have?

Answer 4

Increase in wall thickness and stiffness of the left ventricle. This leads to impaired diastolic filling and possible atrial enlargement

Question 5

What is seen in early LV hypertrophy and later?

Answer 5

Early on you see an increase in myocyte diameter

Later on there is nuclear enlargement and fibrosis

Question 6

What are the two possible causes of pulmonary hypertension?

Answer 6

Cor pulmonale and left side hypertension

Question 7

Resistance in the lungs causes?

Answer 7

Right side hypertrophy

Question 8

What causes acute cor pulmonale? What does this lead to?

Answer 8

Following massive pulmonary embolism which leads to right side dilation

Question 9

What does chronic cor pulmonale cause?

Answer 9

Right ventricular hypertrophy and dilation

Question 10

What is arteriopathy?

Answer 10

When a normal sized artery gains a lot of smooth muscle and angioma like vessels around it

Question 11

Hyaline arteriosclerosis and hyperplastic arteriosclerosis affect vessels of what size?

Answer 11

Smalle

Question 12

Describe the pathogenesis of hyaline arteriosclerosis

Answer 12

1. Chronic hemodynamic stress leads to
2. Plasma proteins leaking from cells
3. Synthesis of smooth muscle matrix causing hyalinized, narrow vessels

Question 13

What are the risks factors for hyaline arteriosclerosis?

Answer 13

Elderly, hypertension, diabetes, nephrosclerosis from hypertension in the kidney

Question 14

Does hyaline arteriosclerosis naturally occur in elderly people?

Answer 14

Yes

Question 15

What causes hyper plastic arteriosclerosis?

Answer 15

Very high blood pressure, >200 mm Hg

Question 16

What will be seen microscopically in hyper plastic arteriosclerosis?

Answer 16

Onion-skin lesions

Question 17

What vessels are affected by atherosclerosis?

Answer 17

Medium and large vessels

Question 18

What is the hallmark of atherosclerosis?

Answer 18

Atherosclerotic plaques

Question 19

What is a risk factor for atherosclerosis that is related to periodontal disease?

Answer 19

C-reactive protein, released in response to the bacteria and also causes atherosclerosis

Question 20

Describe how plaques form

Answer 20

High cholesterol and endothelial cell injury cause local increase in free radicals that oxidize lipid

Lipid is taken in by macrophages that become foam cells

The injured epithelium expresses adhesion molecules that cause T cells to interact with macrophages. They release cytokines that cause smooth muscle and endothelial stimulation

Question 21

Which arteries are targeted by atherosclerotic disease?

Answer 21

The aorta, carotid, iliac, coronary, and popliteal arteries

Question 22

What is atherosclerotic stenosis?

Answer 22

When atherosclerosis occludes the vessel beyond 70%, the critical stenosis point, and ischemic injury occurs

Question 23

What else can affect plaques?

Answer 23

Epinephrine, waking and rising, vasoconstriction due to adrenergic agonists, emotional stress