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Pathology > P12- Hypertension, thrombosis, embolism , Infarction > Flashcards

P12- Hypertension, thrombosis, embolism , Infarction Flashcards

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1
Q

what is systole?

A

left ventricular contraction

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2
Q

what is diastole?

A

left ventricular relaxation

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3
Q

what is blood pressure?

A

cardiac output x peripheral resistance

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4
Q

what contributes to cardiac output?

A
  • heart rate
  • contractility
  • blood volume
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5
Q

Name peripheral resistance constrictors.

A

Angiotensin II , Catecholamines

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6
Q

Name peripheral resistance dilators.

A

Nitric oxide,

Prostaglandins

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7
Q

what is hypertension?

A

‘a disorder in which the level of sustained arterial pressure is higher than expected for the age, sex, and race of the individual’

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8
Q

what is hypertension synonymous with?

A

systemic arterial hypertension

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9
Q

what is high blood pressure ?

A

blood pressure of >140/90 mmHg consistently

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10
Q

Does hypertension affect ages specifically?

A
  • NB age

- Children, adolescent, adult, 3rd decade

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11
Q

what is normal variation of hypertension?

A

Normal variation in individuals at different times of day- lowest levels during sleep

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12
Q

when does BP increase?

A

BP increases on standing up, on exercise and on exposure to cold and emotion

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13
Q

who is at risk of permanent hypertension -labile hypertension?

A

Individuals with a larger than normal pressure rise in response to these stimuli

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14
Q

How is hypertension monitored?

A

24 hr

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15
Q

what are the 2 types of classifications of hypertension?

A
  • according to cause (Aetiological)

- according to consequences (Clinicopathological)

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16
Q

what are the 2 types of “according to cause” hypertension?

A
  • primary

- secondary

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17
Q

what are the 2 types of “according to consequences” hypertension?

A
  • benign

- malignant

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18
Q

what are 95% of cases?

A

no detectable cause- “primary” or “essential” hypertension

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19
Q

Give some causes of primary hypertension?

A
  • Interplay of genetic and environmental factors

* Race, Stress, diet (salt, animal fats), alocohol intake, intrauterine life, exercise

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20
Q

what is secondary hypertension?

A

renal disease, endocrine disorders, aortic disease (Coarcta(on of the aorta ‐ congenital narrowing of segments of the aorta)

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21
Q

what are endocrine causes of hypertension?

A
  • Adrenal gland hyperfunction / tumours
  • Conn’s syndrome - excess Aldosterone
  • Cushing’s syndrome - excess corticosteroid
  • Phaeochromocytoma - excess noradrenaline
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22
Q

what is prognosis of patients with hypertension is related to?

A

height and rate of pressure rise

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23
Q

what is benign hypertension?

A

prognosis is measured in decades

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24
Q

what is malignant hypertension?

A

accelerated form fatal within 2 yrs if untreated

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25
what can benign hypertension cause?
* Iscahemic Heart disease * Heart Failure * Stroke * Acceleration of Renal Disease * Malignant Hypertension
26
what are the symptoms of hypertension?
usually asymptomatic
27
How is bonging hypertension often detected ?
* Often detected in middle age during routine checkup | * BP rises slowly over many years
28
what does benign hypertension affect?
* Affects heart and arteries of all sizes | * Main target organs are heart, brain and kidneys
29
what is the most common complication of benign hypertension?
Ischaemic heart disease is most common complication (insufficient blood supply to the myocardium to meet functional demand)
30
what effect does benign hypertension have on the cardiovascular system?
* Increased pressure causes hypertrophy of the arteries and heart * Resistance arteries have thicker walls and more narrow lumina * Longstanding hypertension aggravates atherosclerosis and contributes to development and rupture of aneurysms and dissections
31
what effect does benign hypertension have on the heart?
* Left ventricular hypertrophy impairs diastolic function * Increased muscle mass and interstitial fibrosis * Poorer coronary artery perfusion * If coronary atherosclerosis, increased oxygen demand of hypertrophied ventricle contributes to ischaemia, even at rest * Leads to cardiac arrhythmias and myocardial infarct
32
what effect does benign hypertension have on the brain?
* Hypertension cause microaneurysms in arteries supplying basal ganglia, pons, cerebellum * Rupture leads to hypertensive cerebral haemorrhages * Also predisposes to cerebral infarction
33
what can occur in a subarachnoid haemorrhage?
rupture of berry aneurysm
34
what effect does benign hypertension have on the kidney?
Hypertension aggravates many renal diseases but only in severe cases does it cause renal failure
35
what are the values for benign hypertension?
* Every 10mmHg of diastolic pressure above 85 doubles risk of MI * Every 8mmHg of diastolic pressure above 85 doubles risk of stroke
36
what is malignant hypertension?
* Serious life-threatening condition * Diastolic pressure >130 mmHg * + Retinal changes of bilateral flame-shaped haemorrhages and /or papilloedema (swelling of optic nerve) * Can develop from either benign primary or secondary hypertension (most common), or arise de-novo * Usually younger people with hypertension 30-40yrs * Needs urgent treatment to prevent death
37
what can malignant hypertensions cause?
* Causes cerebral oedema - seen as papilloedema (swelling of optic disc) * Acute heart failure * Stroke * Acute renal failure * Blood vessels show fibrinoid necrosis and endarteritis proliferans of their walls
38
what are the conclusions of hypertension?
* Hypertension is very common * It is usually asymptomatic * It may be due to an underlying disease * It requires treatment to prevent complications and death * It affects the physiology of several organs
39
what is blood clotting?
Solid mass of blood constituents EXTERNAL to the blood vessel
40
what is blood clotting a defence mechanisms against?
haemorrhage
41
what is blood clotting important in?
trauma and surgery /anaesthetics
42
what is a thrombus?
Solid mass of blood constituents formed WITHIN the blood vessel
43
where does thrombus occur?
Thrombosis occurs most commonly in veins but can occur in arteries
44
what is the risk of thrombosis increased by?
'Virchows triad"
45
what is the Virchows triad?
1. Injury to the VESSEL WALL 2. Alterations in BLOOD FLOW 3. Alterations in blood constituents that increase coagulability
46
what effect does Virchows triad have on vessels?
- loss of endothelial surface | - inflammation
47
what effect does Virchows triad have on flow?
- stasis | - turbulence
48
what effect does Virchows triad have on constituents?
- platelets - coagulation proteins - viscosity
49
what is involved in thrombus formation?
- platelets - coagulation cascade - fibrinolytic cascade
50
Describe the formation of a platelet rich thrombus?
* In rapidly flowing blood, vascular injury results in formation of platelet-rich thrombus which grows by gradual build up of activated platelets and fibrin (white/pale thrombus) * Platelets stick to endothelium and become activated * Coagulation cascade generates fibrin strands * Thrombus occludes the vessel, blood flow slows and red blood cells can adhere to the surface of the thrombus (red thrombus) * Further thrombosis both sides of blockage due to altered flow -propagation
51
what is the fate of thrombus?
* Can be lysed by anticlotting factors * Larger thrombi on vessel wall can reorganise- infiltartion of macrophages and endothelial cells, recanalise, restore blood flow * Some may become detached from vessel wall and move in blood flow to impact downstream (embolism)
52
what is an embolus?
Abnormal material carried in the blood which may block downstream vessels, depending on the size and nature of the material
53
what do large emboli result in?
infarction of the tissue in which the material impacts, eg brain‐stroke
54
Name the major types of embolism.
* THROMBOEMBOLISM * Arterial side , heart to brain and kidney * Venous side, pulmonary circulation * ATHEROEMBOLISM (cholesterol crystals) * FAT EMBOLISM * AIR EMBOLISM * TUMOUR EMBOLISM * SEPTIC EMBOLISM * AMNIOTIC FLUID
55
what happens in deep vein thrombosis?
- post op - bed bound - travel - unilateral leg swelling - oedema - pain
56
what happens in pulmonary thromboembolism?
- sudden onset - potentially life threatening - haemoptysis - breathlessness - cardiovascular collapse and shock - cardiac arrest
57
what is infarction?
Zonal necrosis due to sudden occlusion of blood supply: - anatomy of blood supply is important - atheroma - embolism
58
what is necrosis due to?
lack of oxygen and nutrient
59
How is susceptibility to necrosis varied?
different tissues have different susceptibility
60
what can an infarction be?
fatal
61
what is a myocardial infarct?
Death of myocardial tissue caused by ischaemia (reduction or cessation of blood flow), such that oxygen delivery is not adequate to meet metabolic demands of cells
62
Is ischaemia reversible?
initially reversible - stable angina
63
what does persistent ischaemia lead to?
structural changes then death of myocytes
64
what are most infarcts due to?
thrombosis over atherosclerotic plaque
65
what do complications of myocardial infarct include?
* Arrhythmias * Cardiogenic Shock * Cardiac rupture * Ventricular septal defects * Heart Failure
66
what can re-perfusion result in?
injury to cells not previously affected
67
What is re-perfusion injuring due to?
Due to toxic oxygen species that are over-produced on restoration of blood supply

Pathology (9 decks)

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