Pathology of HTN

Question 1

Right failure associated with more impairment because

Answer 1

no removal of waste and metabolites

Question 2

morphogenesis of HTn in large/medium arteries

Answer 2

accelerated ahterogenesis

degenerative change in vasc walls

risk of aortic disection and cerbrovascular hemorrhage

Question 3

morphology of HTN in small arteries and arterioles

Answer 3

hyaline arterioloscleosis

hyperplastic ateriolosclerosis

Question 4

Hyaline arteriolosclerosis

Answer 4

leakage of plasma across endotheliaum due to HTN

excess matrix production by SMC secondary

pink collagen fibrosis/sclerosis

benign neprhosclerosis

Question 5

hyperplastic arteriolosclerosis

Answer 5

characteristic of malignant HTN

onion skinnig cocentric luminal walls with luminal narrowing

due to replicated basement mem. + smooth muscle

Question 6

termed used in malignant HTN when arteriol changes are associated with fibrinoid necrosis

Answer 6

necrotizing arteriolitis

Question 7

systemic HTN heart disease is ___ sided

Answer 7

left

Question 8

concentric left ventricular hypertrophy in absence of other cardio path

evidence of HTN >140/90

Answer 8

systemic hypertensive heart disease

Question 9

morphology of systemic HTN heart disease

Answer 9

cardiomegaly - 1.5cm wall thickiness

thickiness of LV impairs filling > LA dilatation

Myocyte hypertrophy and nucelar enlargement

Question 10

HTN encephalopathy

Answer 10

Headaches, confusion vomiting convulsions

increased CSF pressure

Question 11

Renal damage of benign HTN

Answer 11

Kidney atrophy with pitted surface

hyaline arteriolosclerosis of vessels > ischemia + atrophy

glommeruli sclerosed

Question 12

renal damage of malignant HTN

Answer 12

pinpoint petechial hem. on surface

fibrinoid necrosis of arterioles

hyperplastic arteriolosclerosis and microthrombi > global ischemia

Question 13

cause and morpholohy COr pulmonaue

Answer 13

Acute due to massive pul embolism

Chronic - secondary to Pul HTN or lung disease

RV hypertrophy

obstruction of pul vessels

Question 14

mechanism of CHF pathogenesis

Answer 14

abnml load on heart (fluid, MI valve dysfunction, ischemic HD, HTN, Dilated CM)

Impaired vent filling: (acute: pericarditis or tamponade, chronic: restrictive CM, severe LV hyper)

obstruction due to valve stenosis (chronic rheumatic mitral)

Question 15

systolic dysfunction in CHF

Answer 15

progressive deterioration of contractilitiy

iscehmic HD, pressure or volume overload, Dilated CM

Question 16

diastolic dysfunction in CHF

Answer 16

inability to relax and fill

LVH

amyloidosis

myocardial fibrosis (from infarct, radiation ect)

consstrictive pericarditis

Question 17

rapidly occuring compensatory mechanisms

Answer 17

Frank starling (increased end diastolic filling vol)

NE release by cardiac nerves (HR, contract, vasc R)

Rening angiotensin aldosterone

atrial natriuretic peptide (dilation, diuresis)

Question 18

pattern of hypertrophy, Pressure overload leads to (morphology)

Answer 18

HTN, aortic stenosis

concentraic hypertrophy

Question 19

paterns of hypertrophy, volume overload leads to (morphology)

Answer 19

mitral or aortic regurgitation

Question 20

cells found in pulmonary edema of left sided failure

Answer 20

heart failure cells (macrophages)

Question 21

physical exam left sided heart failure

Answer 21

dyspnea

orthopenea

paroxysmal nocturnal dyspnea

rales

Question 22

in left sided failure, if kidney perfusion deficiency is severe >

Answer 22

pereneal azotemia (impaired function)

Question 23

cerebral effects of left sided failure

Answer 23

cerebral hypoxia

encepalopathy

Question 24

causes of right sided failure

Answer 24

**secondary to left side **

Pul HTN

Primary myocardial disease

Tricuspid or Pulmonary valve disease

Question 25

Right sided failure kidney impact

Answer 25

congestion, fluid retention, peripheral edea, azotemia more marked than with left sided failure

Question 26

heart impact of right sided failure

Answer 26

RV hypertrophy and dilatation

Question 27

hepatic impact right sided failure

Answer 27

elevated portal pressure > congestive hepatosplenomegaly

cardiac cirrhosis

ascites

Question 28

eventual anscara of Right sided failure

Answer 28

massive edma