Tumors of the Heart and Hypertension

Question 1

describe clinical presentation of heart tumors

Answer 1

• sudden onset of severe, rapidly progressive HF without apparent cause and/or arrhythmia
• silent until it impairs function

Question 2

____ is the most common primary tumor of the heart and is predominantly found in ____

Answer 2

cardiac myxoma is the most common primary tumor of the heart and is predominantly found in females (age 30-60)

Question 3

____ often calcify and can at times be seen on x-ray

Answer 3

cardiac myxomas often calcify and can at times be seen on x-ray

Question 4

describe the gross and histological morphology of cardiac myxomas

Answer 4

• gross:
  
  • lobulated pedunculated mass
  • most common location = LA
• histo:
  
  • multinucleated stellate cells suspended in an edematous mucopolysaccharide rich stroma

Question 5

describe what is seen in the image

Answer 5

Question 6

describe clinical features of cardiac myxoma

Answer 6

• most are asymptomatic
• some may fragment and embolize
• ball-valve obstruction of AV valve → syncopal episodes, sudden death

Question 7

list the most common secondary heart tumors

Answer 7

• direct extension of lung cancer
• breast cancer
• lymphoma
• malignant melanoma

Question 8

list renal causes of secondary hypertension

Answer 8

• renal:
  
  • glomerulonephritis
  • renal artery stenosis
    
    • stenosis perceived as decreased blood supply → produces renin → activates angiotensin system

Question 9

list endocrine causes of secondary hypertension

Answer 9

• endocrine:
  
  • Cushing
  • OCP
  • thyrotoxicosis
  • myxdema
  • pheochromocytoma
  • acromegaly

Question 10

list vascular causes of secondary hypertension

Answer 10

• vascular
  
  • coarctation of aorta
  • polyarteritis nodosa
  • aortic insufficiency

Question 11

list neurogenic causes of secondary hypertension

Answer 11

• neurogenic:
  
  • psychogenic
  • intracranial pressure
  • polyneuritis

Question 12

describe the pathogenesis of essential hypertension

Answer 12

• essential: multifactorial
  
  • increased peripheral resistance (symp. tone)
  • stress, hormonal, neural
  • genetic, familial, life style

Question 13

describe the pathogenesis of secondary hypertension

Answer 13

• secondary: known abnormal control
  
  • increased blood volume → sodium retention, ADH, aldosterone
  • increased symp. tone → adrenal tumors
  • increased vasoactive hormones → Cushing’s, pheochromocytoma

Question 14

describe malignant hypertension

Answer 14

• may complicate any type of HTN
• necrotizing arteriolitis
• rapidly progressive end-organ damage
  
  • renal failure
  • LV failure
  • hypertensive encephalopathy

Question 15

describe how hypertension can affect the large blood vessles

Answer 15

• large blood vessels:
  
  • atherosclerosis

Question 16

describe how hypertension can affect the small blood vessels

Answer 16

• small blood vessels:
  
  • arteriosclerosis
    
    • hyaline and hyperplastic

Question 17

describe how hypertension can affect the heart

Answer 17

• heart:
  
  • LVH, hypertensive cardiomyopathy → IHD, MI

Question 18

describe how hypertension can affect the kidney

Answer 18

• kidney:
  
  • nephrosclerosis: benign and malignant

Question 19

describe how hypertension can affect the eyes

Answer 19

• eyes:
  
  • hypertensive retinopathy

Question 20

describe how hypertension can affect the brain

Answer 20

• brain:
  
  • hemorrhage, infarction

Question 21

describe hyaline arteriosclerosis

Answer 21

• 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

Question 22

describe what is seen in the image

Answer 22

hypertensive vascular disease

hyaline arteriosclerosis; the arteriolar wall is thickened with the deposition of amorphous proteinaceous material (hyalinized) and the lumen is markedly narrowed

Question 24

describe hyperplastic arteriosclerosis

Answer 24

• 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

Question 25

describe what is seen in the image

Answer 25

hyperplastic arteriosclerosis: “onion-skinning” causing luminal obliteration

Question 26

describe necrotizing arteriolitis

Answer 26

• deposits of fibrinoid and acute necrosis of the vessel wall