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Respiratory > Pathology- Hypertension > Flashcards

Pathology- Hypertension Flashcards

1
Q

what is hypertension

A

a disorder in which the level of sustained arterial pressure is higher than the expected for the patient (age, sex and race)

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2
Q

why are repeat measurements important

A

normal variation throughout day,

white coat hypertension,

stable or labile (fluctuates in response to e.g. emotional stress) hypertension

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3
Q

what does hypertension ultimately cause

A

cardiac failure

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4
Q

what is hypertension a risk factor for

A

cerebral haemorrhage,
atheroma,
renal failure,
sudden cardiac death

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5
Q

what is essential in the prevention of risk factors associated with hypertension

A

early detection and treatment

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6
Q

how does the incidence of hypertension vary

A

varies between countries, ethnic groups, genetic link, rises with age

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7
Q

what are the aetiological classifications of hypertension (according to cause)

A

primary (no underlying cause, genetics = environment)

secondary (underlying disease)

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8
Q

what are the classifications of hypertension depending on consequences

A

benign- often primary

malignant- often secondary, extreme kills quickly

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9
Q

how is blood pressure tested

A

CO x TPR

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10
Q

what affects CO

A

HR, contractility, blood volume

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11
Q

what affects peripheral resistance

A

constrictors (angiotensin II, catecholamines)

dilators (nitric oxide, prostaglandins)

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12
Q

what is the primary site of resistance

A

end arterioles

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13
Q

when is renin released by the kidneys

A

when renal blood flow increases

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14
Q

when is ACE found

A

the lungs

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15
Q

how does angiotensin 2 increase blood pressure

A

by vasoconstriction and by increasing blood flow

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16
Q

hoe does agiotensin 2 increase blood flow

A

aldosterone release (salt and fluid retention)

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17
Q

how do ACE inhibitors reduce blood flow

A

stop conversion of angiotensin 1 to angiotensin 2

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18
Q

what is salt sensitive hypertension and how is it controlled

A

increase in dietary salts leads to increase in BP

controlled by reduction in salt in diet

19
Q

what conditions can cause secondary hypertension

A 
Renal disease
					Endocrine disease
					Aortic disease
					Renal artery stenosis
					Drug therapy
20
Q

hoe can renal diseases cause high BP

A

reduced renal blood flow

excess renin release

salt and water overload

21
Q

what renal diseases can cause secondary hypertension

A

renal artery stenosis, acute or chronic glomerulonephritis, chronic pyelonephritis, cystic diseases, interstitial nephritis

22
Q

describe the layers of the adrenal cortex

A

3 layers, each producing different thing (aldosterone, steroid hormone (corticosteroid), noraldrenaline (adrenal medulla))

23
Q

what are the endrocrine causes of secondary hypertension

A

Adrenal gland hyperfunction / tumours

Conn’s syndrome - excess Aldosterone

Cushing’s syndrome - excess corticosteroid

Phaeochromocytoma - excess noradrenaline
24
Q

what is coarctation of the aotra

A

congenital narrowing of segments of the aorta (causes paradoxical hypertension- high in upper body, lower in legs)

25
Q

give an example of a drug that can cause hypertension

A

corticosteroids

26
Q

what does benign hypertension eventually cause

A

Left ventricular hypertrophy
Congestive cardiac failure

Increases atheroma
Increases aneurysm rupture - aortic dissection, Berry aneurysms

Renal disease

27
Q

what is an aneurysm

A

weakening of an artery wall that creates a bulge, or distention, of the artery

28
Q

what does hypertension cause in the in the heart

A

left ventricular hypertrophy

increased LV load

poor myocardial perfusion

interstitial fibrosis

micro-infarcts (myocyte necrosis)

diastolic dysfunction

increased susceptibility to arrhythmias

cardiac failure

29
Q

what does left ventricular hypertrophy cause

A

sudden cardiac death, arrhythmia and poor perfusion, cardiac failure

also affects outcome of other diseases

30
Q

how is hypertension associated with atheroma

A

predisposes and complicates

31
Q

what is aortic dissection

A

where the inner layer of the aorta tears, associated with hypertension

32
Q

what is a subarachnoid haemorrhage

A

when blood leaks into the space between two of the membranes that surround the brain. It is usually caused by a ruptured (berry) aneurysm

33
Q

how does benign hypertension increase the risk of MI

A

Every 10mmHg of diastolic pressure above 85 doubles risk of MI

34
Q

how does benign hypertension increase the risk of stroke

A

Every 8mmHg of diastolic pressure above 85 doubles risk of stroke

35
Q

give four examples of microvascular injuries and its consequences

A

Blood vessel wall changes - small arteries and arterioles

Retina and kidney

Thickening of media (smooth muscle)

Hyaline arteriosclerosis - plasma proteins forced into vessel wall (cf ageing)
36
Q

what is Hypertensive arteriolosclerosis and how is it seen pathologically

A

form of cardiovascular disease involving hardening and loss of elasticity of arterioles or small arteries (associated with hypertension)

scarred granular cortex

37
Q

what diastolic pressure range suggests malignant hypertension

A

more than 130-140

38
Q

what can malignant hypertension develop from

A

benign primary or secondary hypertension

39
Q

what are the complications of malignant hypertension

A

Causes cerebral oedema - seen as papilloedema (swelling of optic disc)
Acute renal failure
Acute heart failure
Headache and cerebral haemorrhage
Blood vessels show fibrinoid necrosis and endarteritis proliferans of their walls

40
Q

what is seen pathologically in afferent kidney arterioles as a result of malignant hypertension

A

Onion skinning of vessel wall and fibrin deposition

41
Q

what does pregnancy associated hypertension increase

A

maternal and fetal morbidity and mortality

42
Q

what is pre-eclampsia

A

hypertension and proteinuria (protein in urine)

43
Q

what is the difference between pre-eclampsia and eclampsia

A

pre resolves at birth

eclampsia obsteric emergency

Respiratory (26 decks)

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