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Cardiology > pathology of hypertension > Flashcards

pathology of hypertension Flashcards

1
Q

What are the pathological complication for hypertension?

A
  • cerebral haemorrhage
  • atheroma
  • renal failure
  • sudden cardiac arrest
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2
Q

What percentage of the population are hypertensive?

A

25%

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3
Q

What is white coat hypertension?

A

increased BP due to hospital setting

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4
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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5
Q

What are key epidemiological points to do with hypertension?

A
  • Varies between countries
  • Higher in black populations
  • Lower in South Pacific
  • Familial tendency
  • Rises with age
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6
Q

How do you classify hypertension according to cause?

A
  • primary hypertension (unknown cause)

- secondary hypertension (known cause)

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7
Q

How do you classify hypertension according to consequences?

A
  • benign hypertension (often primary)

- Malignant hypertension (often secondary)

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8
Q

What is the equation for blood pressure?

A

CO x peripheral resistance

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9
Q

How does peripheral resistance occur?

A

Narrow arterioles cause decrease in blood flow due to resistance. This generates BP

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10
Q

What does further narrowing of arterioles cause?

A

increase BP

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11
Q

Describe RAAS

A
  • Renal blood flow increases causes release of renin
  • converts angiotensin to angiotensin 1
  • which circulates the blood into lungs
  • where meet angiotensin converting enzyme
  • which transforms angiotensin 1 to angiotensin 2.
  • This then causes vasoconstriction and releases aldosterone
  • which causes salt and fluid to remain in body.
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12
Q

what effect has salt got on BP?

A

increases BP

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13
Q

What are key characters of primary hypertension?

A
  • 90% of cases
  • No obvious cause
  • Genetic factors (twin studies)
  • Salt intake -25% salt sensitive
  • Protein intake
  • Renin - Angiotensin system
  • Sympathetic activity
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14
Q

What causes secondary hypertension?

A
  • renal disease
  • endocrine disease
  • aortic disease
  • renal artery stenosis
  • drug therapies ( steroids)
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15
Q

What are the renal causes of hypertension?

A

Anything that destroys the kidney causes

  • reduced renal blood flow
  • excess renin release
  • salt and water overload
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16
Q

What is Chronic pyelonephritis ?

A

Dysfunction of ureters, leading to disruption to renal blood flow and hypertension leading to stroke

17
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
18
Q

What are other causes of hypertension?

A
  • coarctation of the aorta

- drugs including corticosteroids

19
Q

What is coarctation of the aorta?

A

congenital narrowing of segments of the aorta

20
Q

Describe bening hypertension

A
  • slow process
  • cause of serious life threatning morbidity
  • If left untrrated will affect heart kidneys and circulation
21
Q

What conditions can benign hypertension cause?

A
  • Left ventricular hypertrophy
  • Congestive cardiac failure
  • Increases atheroma
  • Increases aneurysm rupture - aortic dissection, Berry aneurysms Renal disease
22
Q

What does left ventricular hypertrophy cause?

A
  • INCREASED LV LOAD
  • POOR PERFUSION
  • INTERSTITIAL FIBROSIS
  • MICRO-INFARCTS
  • DIASTOLIC DYSFUNCTION
23
Q

What other things can left ventricular hypertrophy cause?

A

-SUDDEN CARDIAC DEATH
ARRHYTHMIA AND POOR PERFUSION
-CARDIAC FAILURE

24
Q

What is the difference in aorta in normal patients and hypertensive patients?

A
  • normal - smooth pink wall
  • hypertension - rough yellow.

Hypertensions predisposes to and complicated atherosclerosis

25
Q

What damage does hypertension cause to microvascular injury?

A

changes in blood vessel wall- small arteries and arterioles

  • thickening an hardening of muscle walls
  • hyaline arteriosclerosis
26
Q

Where does most microvascular injury occur?

A

retina and kidney

27
Q

What is hyaline arteriosclerosis?

A

plasma proteins forced into vessel wall (cf ageing)

28
Q

What is the main damage hypertension does to the retina?

A

haemorrhage

29
Q

Describe malignant hypertension

A
  • serious
  • immediate treatment
  • Diastolic pressure >130-140
  • can be caused by primary or secondary hypertension
30
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
31
Q

What dies the vessels look like under the microscope?

A

swirling mass of endothelial cells - no lumen , vessel haemorrhage

32
Q

What happens in pregnancy associated hypertension?

A
  • Common up to 10% pregnancies
  • Increased maternal and fetal morbidity and mortality
  • Pre-eclampsia – hypertension and proteinuria
  • Resolves following birth
  • Eclampsia – obstetric emergency
  • Hypertension secondary to silent renal or systemic disease

Cardiology (32 decks)

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