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CVS Pathology > Pathology 1 - Hypertension > Flashcards

Pathology 1 - Hypertension Flashcards

1
Q

Normal Blood Pressure Value

A

<130/85

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2
Q

High Blood Pressure Value

A

> 140/90

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3
Q

Stages of Hypertension

A

Mild: +20
Moderate: +40
Severe: +80
Malignant: >210/120

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4
Q

Two main factors that regulate BP

A
  1. Cardiac Output -> systolic
  2. Peripheral Resistance -> diastolic
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5
Q

Types of Hypertension

A
  1. Essential Hypertension
  2. Secondary Hypertension
  3. Accelerated/Malignant
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6
Q

Essential Hypertension Criteria

A

95% of cases
idiopathic
key initiating factor: low renal Na excretion
reversible if managed

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7
Q

Etiology of Essential HTN

A

Environmental
Genetic
Increased blood volume
Increased peripheral resistance

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8
Q

Most common of Essential HTN

A

Hyperinsulinemia

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9
Q

Secondary Hypertension Criteria

A

Secondary to pre-existing illness
eg. renal, endocrine, cardiovascular, neurologic

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10
Q

Most common renal causes of 2nd HTN

A

CKD/GN, RAS, Renin/Aldosterone- producing tumours

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11
Q

Most common endocrine causes of 2nd HTN

A

Cushing, CAH, Thyrotoxicosis, Myxoedema, Pheochromocytoma, OCP

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12
Q

Most common vascular causes of 2nd HTN

A

Coarctation of aorta, PAN, aortic insufficiency

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13
Q

Most common neurogenic causes of 2nd HTN

A

Psychogenic, increased intracranial pressure, polyneuritis

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14
Q

Pathogenesis of Renovovascular HTN

A

decreased GFR
Renin stimulation by JGA
Renin will cause:
1. Aldosterone -> Na retention -> increased blood volume
2. Angiotensin II -> vasoconstriction -> increased peripheral resistance

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15
Q

Malignant HTN Criteria

A

Sudden/Sustained diastalic BP >120 mmHg
Associated with end stage organ damage
Progressive and fatal

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16
Q

Factors which can complicate HTN

A
  • Arterial necrosis with thrombosis
  • Rapidly developing renal failure
  • Hypertensive encephalopathy (papilledema)
  • Left ventricular failure
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17
Q

What causes histopathological and tissue changes in HTN

A

arteriolopathy (pathological changes in arteriolar wall

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18
Q

What are the histopathological and tissue changes in HTN

A
  • Thickening of arterioles
  • Thinning of the arterioles
  • Necrosis of the wall of the arterioles
  • Hyaline changes of the muscle coat of the arterioles
  • Atherosclerosis of the arterioles
  • Aneurism of the arterioles
  • Thrombosis of the lumen of the arterioles
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19
Q

What 2 main things will the arteriole changes lead to

A
  1. Ischemia
  2. Hemorrhage
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20
Q

Pathophysiology of ischemic infarction

A
  1. atherosclerosis/smooth muscle hypertrophy
  2. narrowing of bv
  3. no oxygen supply
  4. tissue infarction healed by scarring
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21
Q

Example of ischemic infarction

A
  • Hypertensive nephropathy
  • Ischemic heart disease
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22
Q

Pathophysiology of hemorrhage

A
  1. Thin/abnormally dilated vessel wall
  2. Aneurysm
  3. Rupture in brain/retina
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23
Q

Effect of HTN on large BV

A

Macroangiopahy
Atherosclerosis and its complications
causes structural changes that potentiate AD & CVA

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24
Q

Effect of HTN on small BV

A

Hyaline and Hyperplastic arteriosclerosis

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25
Q

Definition of Hyaline Arteriosclerosis

A

Homogenous pink hyaline thickening of the arteriole wall
Loss of underlying structural details and narrowing of the lumen

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26
Q

Demographic of Hyaline Arteriosclerosis

A
  • Old patients
  • Hypertensive patients (severe hyaline change)
  • Diabetic patient (diabetic microangiopathy)
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27
Q

Pathogenesis of Hyaline Arteriosclerosis

A
  • HTN leads to leakage of plasma proteins
  • bind to endothelial layer
  • excess extracellular matrix is formed by smooth muscle cells
  • benign
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28
Q

Where does Hyaline Arteriosclerosis occur

A
  • benign nephrosclerosis
  • arterial narrowing -> impaired renal blood flow w/loss of nephrons
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29
Q
A

Hyaline Arteriosclerosis

30
Q

Definition of Hyperplastic Arteriosclerosis

A
  • laminations of smooth muscle cells with thickening and proliferation of the basement membrane
  • onion skin appearance
  • malignant
31
Q

Demographic of Hyperplastic Arteriosclerosis

A

malignant hypertension (diastolic >120)

32
Q

Complication of Hyperplastic Arteriosclerosis

A

Cerebral and renal injury

33
Q

Presentation of Hyperplastic Arteriosclerosis in patient with malignant HTN

A

accompanied by fibrinoid deposits and necrotizing arteriolitis (vessel wall necrosis)

34
Q
A

Hyperplastic Arteriosclerosis

35
Q
A

Necrotizing arteriole
- Necrosis = rough surface =blood cant move smoothly = thrombosis

36
Q

Effect of HTN on heart

A

LVH, Hypertensive cardiomyopathy (CAD, HF, CA) -> IHC/MI

37
Q

Effect of HTN on kidney

A

benign nephrosclerosis

38
Q

Effect of HTN on eyes

A

Hypertensive retinopathy

39
Q

Effect of HTN on brain

A

intracerebral hemorrhage, lacunar infarcts, hypertensive encephelopathy

40
Q

How does HTN predispose to ventricular hypertrophy

A

increased vascular resistance

41
Q

How does HTN predispose to ventricular hypertrophy

A

increased vascular resistance
vessels narrow
myocardium needs to work harder to pump blood
ventricle thickens

42
Q

Describe the presentation of left ventricular hypertrophy

A

concentric and diffuse hypertrophy (not focal)

43
Q

Define Aortic Dissection

A

Tear in the wall that causes blood to flow between the layers of the wall of the aorta and forces the wall appart

44
Q

Consequence of Aortic Dissection

A

Medical emergency
Complete tear -> massive and rapid blood loss
90% mortality

45
Q

Etiology of Aortic Dissection

A

Hypertension (70-80%)
Connective tissue disorders (Marfan - 5-9%, proximal dissection, Turner - aortic root dilation)
Vasculitis (rare)
Chest trauma (blunt chest trauma, latrogenic - cardiac catherization, intra-aortic balloon pump)

46
Q

Pathogenesis of aortic dissection

A

lumen narrowed by dissection
causes a balloon of blood that will eventually rupture
thoracic cavity will be filled with blood

47
Q

Type of Aortic Dissection

A
  • Type A: Aorta
  • Type B: subclavian artery
48
Q

What type of Hypertensive Nephropathy is found in Benign HTN

A
  • Hyaline arteriosclerosis
  • Consequent ischemia
  • Tubular atrophy, interstitial fibrosis, sclerosis of glomeruli
  • Subscapular scars (granular surface and contracted kidney)
  • Renal failure
49
Q

What type of Hypertensive Nephropathy is found in Malignant HTN

A
  • Acute renal failure
  • Papilledema
  • Encephalopathy
  • Heart failure
50
Q

Pathogenesis of Hypertensive Nephropathy is found in Malignant HTN

A

severe increase in BP ->
- endothelial injury
- thrombosis
- intravascular coagulation
= ischemia

51
Q

Phases of Hypertensive Nephropathy is found in Malignant HTN

A

Acute: fibrinoid necrosis of vessel wall, intravascular thrombosis
Chronic: hyperplastic arteriosclerosis, ischemic glomerular sclerosis

52
Q

Nephrosclerosis

A
  • typical appearance of HTN
  • leathery granularity due to minute scarring
  • hyalinization/hyperplasia of capillaries -> pinpoint necrosis
    -fibrosis in certain areas
53
Q

Chronic pyelonephritis

A

coarse granularity due to inflammation healed by fibrosis

54
Q
A

-nephrosclerosis
- narrowed blood vessels
- dead areas and viable areas

55
Q
A

nephrosclerosis

56
Q

2 types of cerebral hemorrhage

A
  1. intracerebral
  2. subarachnoid
57
Q
A

intracerebral hemorrhage with extension to the venticular system

58
Q
A

intracerebral hemorrhage with extension to the ventricular system

59
Q
A

sub arachnoid hemorrhage (cerebral blood vessels)
- thin walled
-end arteries
- cong. aneurisms

60
Q

2 Types of brain infarction in HTN

A
  1. Ischemic infarction
  2. Hemorrhagic infarction
61
Q
A

area surrounding the hemorrhage will be nechrotic due to low/no oxygen supply

62
Q

2 types of ischemic infarcts

A
  1. lacunar infarcts
  2. cerebral infarcts
63
Q

what are infarcts

A

arteriolar occlusion of deep penetrating arterioles of pons
most common in basal ganglia, deep white matter and brain stem

64
Q
A

lacunes - single or multiple cavitary infarcts

65
Q
A

cerebral infarction - due to ischemia as a result of hyaline arteriosclerosis

66
Q
A

lacunar infarct
cystic space from the resolved liquefactive necrosis
hemosiderin may be present from hemorrhage

67
Q

Renal causes of hypertension (6)

A
  • Renal artery stenosis (atherosclerosis, fibromuscular dysplasia)
  • Polycystic disease
  • Glomerulonephritis (acute/chronic)
  • Renal vasculitis (SLE)
  • Renin producing tumours (reninoma)
  • Catecholamine producing tumour (pheochromocytoma)
68
Q

Presentation of hypertensive retinopathy (4)

A
  • arteriosclerosis causes arteriole light reflex to become broad and dull (silver wire)
  • generalized or focal retinal arteriolar constriction (pale)
  • small flame-shaped hemorrhage
  • Small white foci of retinal ischemia (cotton wool spots)
  • Yellow hard exudates, due to lipid deposition
69
Q

Staes of hypertensive retinopathy

A

Grade 1: thickening of arterioles
Grade 2: focal arteriolar spasms, vein constriction, AV nipping
Grade 3: hemorrhages , dot-blot and cotton wool, hard waxy exudates
grade 4: papilloedema

70
Q
A
  • Disc edema with HTN
  • splinter hemorrhages

CVS Pathology (7 decks)

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