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Pathology Exam 2 > Lecture 13 - CV 1 - Arteriosclerosis and Hypertension > Flashcards

Lecture 13 - CV 1 - Arteriosclerosis and Hypertension Flashcards

1
Q

what is the definition of arteriosclerosis

A

hardening of the arteries

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2
Q

what are the different types of arteriosclerosis

A
  1. Atherosclerosis
  2. Monckeberg’s medial calcific sclerosis
  3. Arteriolosclerosis (hyaline or hyperplastic (proliferative))
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3
Q

what is the definition of atherosclerosis?

A

characterized by the atheroma, involved large and medium arteries
*Reaction to injury

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4
Q

what is the definition of Monckeberg’s medial calcific sclerosis

A

medial calcification without luminal narrowing or intimal disruption

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5
Q

What is hyaline type arteriosclerosis, and what are some conditions that can cause it?

A

thickening of basement membrane

Examples: hypertension and diabetes mellitus

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6
Q

what is the hyperplastic (proliferative) type of arteriosclerosis?

A

fibrocellular intimal thickening

Examples: malignant hypertension and scleroderma

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7
Q

what are the non-modifiable risk factors of arteriosclerosis?

A
  1. Age - risk of acute myocardial infarction (MI - “heart attack”) INCREASES 5X IN MEN BETWEEN 40 AND 60 YEARS
  2. Gender: men > postmenopausal women
  3. Genetics - MOST IMPORTANT FACTOR - family history of MI
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8
Q

what is the most important non-modifiable risk factor of arteriosclerosis?

A

genetics - family history of MI

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9
Q

What are potentially modifiable risk factors for arteriosclerosis?

A
  1. Cigarette smoking - 1 pack per day increases death rate by 200%, after cessation, risk gradually decreases
  2. Diabetes mellitus
  3. Hypertension - no specific level identifies increased risk
  4. Hypercholesterolemia, the higher the level of cholesterol and LDL (“bad cholesterol”) the greater the risk (especially above 160 mg/dl). High density lipoprotein cholesterol (HDL “good cholesterol”) is inversely associated with atherosclerosis
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10
Q

What are some additional risk factors for arteriosclerosis?

A
  1. Inflammation (C reactive protein, CRP - inflammatory marker)
  2. Hyperhomocysteinemia
  3. Lipoprotein (a) levels
  4. Metabolic syndrome (obesity)
  5. Type A personality (stress)
  6. Lack of exercise
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11
Q

what are the 6 common sites of atheroma formation?

A
  1. Major arterial branch points
  2. Abdominal aorta
  3. Coronary arteries
  4. Popliteal arteries
  5. Carotid arteries
  6. Cerebral arteries
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12
Q

what are the morphologic features of atherosclerotic plaque?

A
  • plaques contain collagen, lipid, myofibroblasts, macrophages, neovascularization
  • A fibrous cap, composed of smooth muscle cells (myofibroblasts) and collagen, develops over a central core of lipid/cellular debris with cholesterol
    3. Progressive changes in plaques include ulceration, fissure formation, thrombosis, embolization (thrombus or debris from the central core), calcification, hemorrhage into the plaque from neovascularization
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13
Q

when do fatty streaks occur in atherosclerotic and nonatherosclerotic prone geographic areas?

A

in infants and children

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14
Q

fatty streaks are characterized by what?

A

lipid-laden cells in the intima

*They can regress, some may progress to atheromas

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15
Q

What are the complications of atherosclerosis (5 of them)

A
  1. Ischemic heart disease
  2. Cerebral vascular accident (stroke)
  3. Gangrene
  4. Nephrosclerosis
  5. Aneurysm formation due to pressure atrophy of the media with altered balance of collagen synthesis/ degradation
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16
Q

what is the prevalence in adults of hypertension in the US?

A

25%

17
Q

the prevalence of hypertension increases with increasing _____

A

age

18
Q

what is the normal systolic/ diastolic BP

A

less than 140/90

19
Q

what BP is the classification of moderate/ severe hypertension?

A

more than 160/106

20
Q

what BP is classified as mild hypertension?

A

equal to 140/90 or 159/104

21
Q

essential hypertension accounts for ___% or more of all hypertension

A

90%

22
Q

what are the contributing factors of essential hypertension?

A 
genetics
stress
obesity
increased salt intake
inactivity
cigarette smoking
23
Q

If essential hypertension is untreated what can happen?

A

it tends to get higher and shortens life expectancy

24
Q

In essential hypertension most patients have what symptom?

A

trick question!

Most patients have no symptoms until organ damage has occurred

25
Q

High blood pressure can cause what side effects?

A

headaches
fatigue
dizziness
palpitations

26
Q

what are the different pathologies of essential hypertension?

A
  • concentric left ventricular hypertrophy (compensated)
  • Left ventricular hypertrophy plus dilation and congestive heart failure (decompensated)
  • Atherosclerosis leads to ischemic heart disease, stroke and ischemic injury to other organs
  • Arteriolosclerosis leads to retinal injury (visual disturbances) and kidney damage or nephrosclerosis (renal failure)
27
Q

a complication from hypertension includes dissecting hematoma of the ____ - longitudinal tear in the media

A

aorta

28
Q

What is the pathogenesis of hypertension (environmental and hereditary factors)?

A
  • peripheral vascular resistance (vasoconstriction)

- reduced sodium excretion - salt and water retention - increased plasma volume and cardiac output

29
Q

in secondary hypertension there are many diseases which may produce hypertension, and the hypertension is controlled when what is treated?

A

the hypertension is controlled when the underlying disease is treated

30
Q

In malignant hypertension there is relatively rapid onset of what?

A

very high blood pressure

*This is a medical emergency requiring prompt but cautious blood pressure lowering

31
Q

what are some complications of malignant hypertension?

A
  • cerebral edema with papilledema
  • retinal hemorrhage
  • severe headaches
  • vomiting
  • convulsions
  • transient blindness
  • encaphalopathy
  • renal failure
  • heart failure
  • cerebral hemorrhage
32
Q

what is a atherosclerotic plaque made of?

A

fibrous cap
central lipid core
progressive changes

33
Q

what are complications of atherosclerosis?

A 
heart
brain
kidneys
lower legs/ feet
AAA
34
Q

what are some complications of hypertension?

A
  • heart (compensated - decompensated)
  • arteries (arteriosclerosis, arteriolosclerosis, dissecting hematoma)
  • kidneys (nephrosclerosis)

Pathology Exam 2 (8 decks)

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