Hypertension Pathology

Question 1

What are 4 ocular features of malignant hypertension?

Answer 1

1. Flame Hemorrhage
2. Papilloedema
3. Hard Exudates
4. Cotton Wool Spot

Question 2

What are the pathological effects of Hypertension (Blood Vessels)?

Answer 2

1. Atherosclerosis
2. Arteriolosclerosis (hyaline or proliferative thickening of arterioles)
   - Hyaline Arteriolosclerosis (benign HT): Hyaline Thickening = Narrowing E.g., renal nephrosclerosis
   - Hyperplastic Arteriosclerosis (Malignant HT): “onion-skin” concentric laminated thickening = fibrinoid necrosis of vessel wall
3. Aneurysms

Question 3

Talk about Hyaline Arteriolosclerosis

Answer 3

1. Bright pinkish exudate of plasma proteins collecting in the subendothelial layer
2. Lumen Narrowed – can cause ischemia to surrounding tissues (e.g., renal tubules, glomerulus = Acute Kidney Injury (vessels filled with thrombotic microangiopathy) = Rise in serum creatinine
3. Increased Smooth Muscle Synthesis

Question 4

Talk about hyperplastic arteriolosclerosis

Answer 4

1. Concentric Lamellated luminal narrowing
2. Lamellation consists of smooth muscle cells with duplication of basement membrane
3. Necrosis of Vessel Wall

Question 5

What are the pathological effects of hypertension (heart)?

Answer 5

1. Hypertensive Heart Disease
   - LV pressure overload = LV hypertrophy (new sarcomeres form parallel to long axis of cell)
   - Impaired LV diastolic filling = left atrial dilation = LV failure

Question 6

What happens in LV hypertrophy in Hypertension?

Answer 6

Increase in transverse diameter due to increase in mitochondria & DNA replication, but not in line with cell division – hence bigger cells

Question 7

What are the pathological effects of hypertension (kidney & CNS)?

Answer 7

Kidney
1. Nephrosclerosis = interstitial fibrosis in kidney

CNS
1. Cerebral hemorrhage (inside brain parenchyma & subarachnoid space + basal ganglia, thalamus, cerebellum)
2. Cerebral Thrombosis
3. Hypertensive Encephalopathy (a/w malignant HTN; characterised by diffuse cerebral dysfunction [brain is edematous, transtentorial herniation]
4. Aneurysm in brain
- lacunar infarction affecting basal ganglia
- charcot-bouchard aneurysm – seen particularly in basal ganglia (microaneurysms are prone to rupture – cerebral hemorrhage