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W1, 2 HTN (pathology) Flashcards

1
Q

What is blood pressure?

A

Pressure exerted on the artery walls by circulating blood

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2
Q

What is high blood pressure?

A

It is sustained increase in BP
(Greater than 140/90 is high BP)

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3
Q

What is normal BP?

A

<130 systolic
< 85 diastolic

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4
Q

What is mild, moderate, severe, malignant hypertension?

A
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5
Q

Why is HTN called the silent killer?

A
  • Rarely show any symptoms
  • painless, Complications bring to diagnosis but late…
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6
Q

What are some symptoms of HTN?

A

dizziness, headache, and visual difficulties

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7
Q

Why patients with HTN present with blurred vision?

A

because Leakage of proteins causes edema and this causes haziness But If hemorrhage occurs, this lead to Blindness

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8
Q

A. Hypertension is a risk factor for ….. & ….. ?
B. It can directly cause ….. & ….. & …….
(What diseases/ conditions?)

A

A. coronary artery disease + cerebrovascular accident/stroke
B. congestive heart failure + renal failure + aortic dissection

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9
Q

HTN usually does not have symptoms but if the patient in the higher level of the disease first thing he will present with is ……………. ?

A

headache & it is throbbing pain affecting the nerves (it is not frontal headache that caused by sinusitis, etc.)

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10
Q

What factors control blood pressure?

A

1- cardiac output (SV) that correlates with Systolic BP
2- peripheral resistance (Tonicity of the total peripheral
resistance arterioles) that correlate with diastolic BP.

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11
Q

How to calculate blood pressure?

A

BP = Cardiac Output x Peripheral Resistance

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12
Q

How do the following endocrine factors affect blood pressure:
A. Renin?
B. Angiotensin?
C. Aldosterone?
D. ANP?
E. ADH?

A

A. Increases BP
B. Increases BP
C. Increases BP
(NOTE: renin, angiotensin, aldosterone work together —> sodium & water retention thus inc blood volume & pressure)

D. ANP: Decreases BP (vasoconstriction of vessels supplying glomeruli thus more sodium& water escape)

E. ADH: Increases BP (acts on BV -constrict- & kidneys)

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13
Q

How do the following neural factors affect blood pressure:
Sympathetic vs parasympathatic?

A

Sympathetic = increases BP
Parasympathatic = decreases BP

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14
Q

How do the following factors (blood volume) affect blood pressure:
A. Sodium?
B. Mineralocorticoids?

A

Both increase blood pressure

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15
Q

Which of the previously mentioned factors affect BOTH cardiac output and peripheral resistance ?

A

ANP & aldosterone

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16
Q

Endocrine factors + neural factors + Blood volume + cardiac factors (HR & contractility) will affect …. only?

A

Cardiac output/ stroke volume

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17
Q

Blood pressure modulation and regulation by effects on cardiac output and peripheral resistance (slide)

A
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18
Q

What increases preload or contractability thus increasing CO / PR ?

A
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19
Q

What are the three types of HTN?

A
  • essential HTN
  • Secondary HTN
  • Accelerated or malignant HTN
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20
Q

95% of cases of HTN are of which type?

A

Essential Hypertention (idiopathic )

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21
Q

What are the causes of essential HTN?

A
  • low renal Na excretion
  • obesity & diet
  • lifestyle (sedentary, smoking)
  • idiopathic
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22
Q

Essential HTN (slide)

A
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23
Q

How is obesity risk factor hypertension?

A

Obesity: fats in the connective tissue surrounding the blood vessel will compress the vessel causing constriction, because of that losing weight lowers blood pressure
Mostly because of smoking, obesity environmental factors

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24
Q

How is smoking a risk factor hypertension?

A

Smoking: particles from the lung then to circulation causing irritation of vessels and vasculitis
(Buerger’s Disease يقطعون ريولهم بسبب الالتهاب بالأوعية)

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25
Hypothetical scheme for the pathogenesis of essential hypertension (slide)
26
What is secondary HTN?
There is a disease or pathology that cause HTN, mostly renal problems, also Heart problems, vessel problems e.g. the shape or structure aorta is not normal so there is a constriction, polyarthritis nodosa (related to vasculitis)
27
Types and causes of secondary HTN
28
Renal causes of secondary HTN?
Chronic kidney disease/Glumerulonephritis Renal artery stenosis Renin/aldoserone-producing tumors
29
Endocrine causes of secondary HTN?
- Cushing - congenital adrenal hyperplasia - thyrotoxicosis - myxedema - pheochromocytoma - oral contraceptive pills
30
Vascular causes of secondary HTN?
- Coarctation of Aorta - polyarthritis nodosa - Aortic insufficiency
31
Neurogenic causes of secondary HTN?
- Psychogenic - high intracranial pressure - polyneuritis
32
Blood pressure variation and the renin angiotensin system (slide)
33
Pathogenesis of Renovascular HTN (slide)
34
What is Malignant Hypertension?
Sudden or sustained diastolic blood pressure of 120 mmHg or more associated with end organ damage.
35
Malignant HTN (slide)
36
What are the histopathological and Tissue changes in hypertension?
• Thickening of the arterioles. • Thinning of the arterioles. • Necrosis of the wall of the arterioles. • Hyaline changes of the muscle coat of the arterioles. • Atherosclerosis of the arterioles. • Aneurism or dilatation of the arterioles. • Thrombosis of the lumen of the arterioles.
37
Changes are basically due to …………. = pathological changes in the arteriolar wall.
arteriolopathy
38
Arteriolar changes will lead to:
- ischemia - hemorrhage
39
What is the effect of Hypertension on blood vessels?
40
Pathogenesis of vascular changes (slide)
41
Types of arteriosclerosis?
• Hyaline arteriolosclerosis • Hyperplastic arteriolosclerosis
42
What is Pathogenesis of Hyaline arteriolosclerosis?
Pathogenesis: Chronic hemodynamic stress of the hypertension leads to leakage of plasma proteins across the vascular wall through the endothelial layer and excess extracellular matrix is also formed by smooth muscle cells.
43
Hyaline arteriolosclerosis occurs in ….. ?
Occurs in: benign nephrosclerosis, arterial narrowing impairs renal blood flow, with loss of nephrons.
44
Hyaline arteriosclerosis (slide)
45
Onion skin appearance
Hyperplastic arteriolosclerosis
46
Hyperplastic arteriolosclerosis: a. Occurs with ..? b. Causes ..? c. Pathogenesis ?
47
Identify A, B, C
A = normal B = hyaline C = hyperplastic arteriosclerosis
48
What do you see in the field?
49
Complications of Hypertention
50
Hypertensive heart disease
51
Why does HTN cause the wall to thicken?
52
Left Ventricular Hypertrophy (slide)
53
Aortic dissection (definition & causes)?
- Definition: Aortic dissection is a tear in the wall that causes blood to flow between the layers of the wall of the aorta and force the layers apart. - causes? Picture attached
54
Aortic dissection (slide)
55
How does benign HTN cause hypertensive nephropathy?
56
Pathogenesis of nephropathy due to malignant HTN
57
Malignant hypertension: A. Acute phase B. Chronic phase
58
What do you see?
Fibrinoid Necrosis- Malignant Hypertension
59
Describe nephrosclerosis?
60
What do you see?
61
What do u see?
62
What do you see?
Fibrin (hyaline) thrombi in glomerular capillaries- Malignant Hypertension
63
Types of Cerebral haemorhage?
1. Intracerebral hemorrhage 2. Subarachnoid hemorrhage (more common)
64
What do you see?
Intracerebral hemorrhage with extension to the ventricular system
65
What are the features of subarachnoid hemorrhage?
66
Infarctions in the brain (types?)
1. Ischemic infarction. 2. Hemorrhagic infarction.
67
Hemorrhagic infarction (slide)
68
Ischemic infarcts most common locations?
Most common in basal ganglia, deep white matter, and brain stem.
69
Types of ischemic infarcts?
70
What do you see?
71
Renal Causes of hypertension
72
How does Hypertensive retinopathy happen?
73
Describe grade 1, 2, 3, & 4 of Hypertensive retinopathy?
74
What do u see?
Disc oedema with splinter hemorrhages caused from severe hypertension
75
Slide read no Qs
76
Conclusion slides
77
precautions of HTN?
78
Self assessment Qs (slide)
79
Mcqs:
7 - B 8- A
80
All A
81
All A except Q 23 is B
82
27 D 28 D 29 A 30 A

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