Path: HTN, Aorta, PAD Flashcards
What are the two causes of renal stenosis in secondary hypertension?
Atherosclerotic Plaque (90%) Fibromuscular Dysplasia (10%)
Common population associated with fibromuscular dysplasia.
Young women
Two common conditions associated with coarctation of the aorta.
Marfans and Turners
any connective tissue disturbance in the aorta is associated with these two
PE findings in patients with coarctation.
Typically high bp in upper extremities and low bp in lower.
3 main organs or organ systems involved in Hypertensive Emergency (Malignant hypertension).
- CNS
- Kidney
- Heart
Gross appearance of the kidney resulting from malignant hypertension.
“Flea-bitten” appearance due to many small petechial hemorrhages.
(fibrinoid necrosis viewed on microscopy)
Characteristic appearance of the retina resulting from malignant hypertension.
“Cotton Wool” appearance
Flame Hemorrhages
What are Charcot-Bouchard microaneurysms?
Small vessel aneurysms seen near the basal ganglia in the brain due to malignant hypertension.
What is the pathogenesis of hypertensive encephalopathy due to malignant hypertension?
High cerebral blood pressure leads to edema and increased intracranial pressure with fibrinoid necrosis of arterioles.
What two physiologic components regulate blood pressure?
Cardiac Output and Total Peripheral Resistance
What is a common microangiopathy of diabetics?
Hyaline Arteriolosclerosis
Condition that occurs in malignant hypertension that leads to “onion skin” appearance.
Hyperplastic Arteriolosclerosis
-onion skin is due to replicating smooth muscle and basement membrane cells due to increased bp.
What is a typical bp in patients that suddenly develop malignant hypertension?
~200/120
Most common site of aortic aneurysms.
Abdominal aorta distal to renal artery branches.
What is Cystic Medial Degradation?
All the microscopic changes that occur to lead to aneurysms in vessel walls.
- fibrosis
- loss of smooth muscle nuclei
- elastic fragmentation
What is the difference between Type A and Type B aortic dissection?
Type A: involves ascending aorta
Type B: does not involve ascending aorta
Complication of a very proximal aortic dissection that occurs near the origin of the aorta.
Cardiac Tamponade
-the fibrous pericardium blends with the adventitia of the aorta as it leaves the heart. Dissection here can lead to bleeding into the pericardial sac.
What is Giant Cell Arteritis?
Vasculitis in the arteries in the head (temporal most common). Involves granulomatous inflammation including giant cells (fused WBCs, usually macrophages) along with elastic lamina fragmentation.
Describe Takayasu Arteritis.
Granulomatous (giant cell) vasculitis of medium and large vessels. Most commonly affects main aortic arch branches leading to weakened upper extremity pulses.
Location of Polyarteritis Nodosa.
Systemic small to medium sized artery vasculitis. Occurs in renal and most visceral vessels EXCLUDING the pulmonary vessels.
What is Kawasaki Disease?
Autoimmune vasculitis usually in response stimulated by recent pathogen infection. Commonly affects the coronary arteries.
What is Microscopic Polyangiitis?
Necrotizing or Leukoclastic vasculitis of the small arteries or capillaries. Commonly seen in the glomerulus and pulmonary circulation.
What is Churg Strauss Syndrome?
Allergic granulomatosis and angiitis. Associated with asthma and allergic rhinitis. Granulomas often accompany eosinophils on microscopy.
What is Wegener Granulomatosis?
A necrotizing vasculitis that presents in a triad:
- Acute Necrotizing granulomas in URT and LRT
- Granulomatous Vasculitis
- Renal Disease showing crescentic glomerulonephritis on microscopy
Patients often have hemoptysis due to alveolar hemorrhage.
How do patients with Thromboangiitis Obliterans (Buerger Disease) present?
Young male smoker that has pain in his legs when he walks.
What is Buerger Disease?
Thrombosing and inflammation in medium sized arteries (commonly tibial and radial).
What is Raynaud Phenomenon?
Exaggerated vasoconstriction of digital arteries and arterioles. Shows red, white, blue appearance.
Primary: caused by cold or emotional stress
Secondary: caused by vascular insuffieciency due to other disease (SLE, Buerger, atherosclerosis)
