Tumors of the Heart and Hypertension Flashcards
describe clinical presentation of heart tumors
- sudden onset of severe, rapidly progressive HF without apparent cause and/or arrhythmia
- silent until it impairs function
____ is the most common primary tumor of the heart and is predominantly found in ____
cardiac myxoma is the most common primary tumor of the heart and is predominantly found in females (age 30-60)
____ often calcify and can at times be seen on x-ray
cardiac myxomas often calcify and can at times be seen on x-ray
describe the gross and histological morphology of cardiac myxomas
- gross:
- lobulated pedunculated mass
- most common location = LA
- histo:
- multinucleated stellate cells suspended in an edematous mucopolysaccharide rich stroma
describe what is seen in the image
describe clinical features of cardiac myxoma
- most are asymptomatic
- some may fragment and embolize
- ball-valve obstruction of AV valve → syncopal episodes, sudden death
list the most common secondary heart tumors
- direct extension of lung cancer
- breast cancer
- lymphoma
- malignant melanoma
list renal causes of secondary hypertension
- renal:
- glomerulonephritis
- renal artery stenosis
- stenosis perceived as decreased blood supply → produces renin → activates angiotensin system
list endocrine causes of secondary hypertension
- endocrine:
- Cushing
- OCP
- thyrotoxicosis
- myxdema
- pheochromocytoma
- acromegaly
list vascular causes of secondary hypertension
- vascular
- coarctation of aorta
- polyarteritis nodosa
- aortic insufficiency
list neurogenic causes of secondary hypertension
- neurogenic:
- psychogenic
- intracranial pressure
- polyneuritis
describe the pathogenesis of essential hypertension
- essential: multifactorial
- increased peripheral resistance (symp. tone)
- stress, hormonal, neural
- genetic, familial, life style
describe the pathogenesis of secondary hypertension
- secondary: known abnormal control
- increased blood volume → sodium retention, ADH, aldosterone
- increased symp. tone → adrenal tumors
- increased vasoactive hormones → Cushing’s, pheochromocytoma
describe malignant hypertension
- may complicate any type of HTN
- necrotizing arteriolitis
- rapidly progressive end-organ damage
- renal failure
- LV failure
- hypertensive encephalopathy
describe how hypertension can affect the large blood vessles
- large blood vessels:
- atherosclerosis
describe how hypertension can affect the small blood vessels
- small blood vessels:
- arteriosclerosis
- hyaline and hyperplastic
- arteriosclerosis
describe how hypertension can affect the heart
- heart:
- LVH, hypertensive cardiomyopathy → IHD, MI
describe how hypertension can affect the kidney
- kidney:
- nephrosclerosis: benign and malignant
describe how hypertension can affect the eyes
- eyes:
- hypertensive retinopathy
describe how hypertension can affect the brain
- brain:
- hemorrhage, infarction
describe hyaline arteriosclerosis
- homogenous, pink, hyaline thickening of the walls of the arterioles with loss of underlying structural details and with narrowing of the lumen
- leakage of plasma components across vascular endothelium and increasing ECM matrix production by smooth muscle cells
- chronic hemodynamic stress in HTN or metabolic stress in diabetes accentuates endothelial injury
describe what is seen in the image
hypertensive vascular disease
hyaline arteriosclerosis; the arteriolar wall is thickened with the deposition of amorphous proteinaceous material (hyalinized) and the lumen is markedly narrowed
describe hyperplastic arteriosclerosis
- related to more acute or severe elevations of blood pressure
- onion-skin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumen
describe what is seen in the image
hyperplastic arteriosclerosis: “onion-skinning” causing luminal obliteration
