101314 path of HTN

Question 1

HTN effects on morphology of small arteries or arterioles

Answer 1

hyaline arteriolosclerosis

hyperplastic arteriolosclerosis

Question 2

hyaline arteriolosclerosis

Answer 2

benign
with age
seen in also benign nephrosclerosis

homogeneous pink, thickening of vessels with narrowing of lumen (due to leakage of plasma across endothelium as a result of HTN-when this leakage occurs, sm musc cells produce excess matrix)

(when you increase pres, the endothelial barrier fails)

Question 3

hyperplastic arteriolosclerosis

Answer 3

characteristic of malignant HTN

Question 4

what is a characteristic feature of hyperplastic arteriolosclerosis

Answer 4

onion skinning, concentric laminated walls with luminal narrowing due to reduplicated basement membrane and sm musc cells

Question 5

necrotizing arteriolitis

Answer 5

term used when malignant HTN is associated with fibrinoid necrosis

bad, end stage of arterioles

irregular fibrin deposition as cells die in the wall

Question 6

systemic hypertensive heart disease

Answer 6

concentric left ventricular hypertrophy IN THE ABSENCE of other cardiovascular pathology

history of pathologic evidence of HTN

affects 25% of US population

Question 7

morphology of systemic hypertensive heart disease

Answer 7

cardiomegaly-concentric hypertrophy w/o dilatation (greater than 1.5 cm wall thickness)

myocyte HYPERTROPHY (increase myocyte size and nuclear enlargement)

Question 8

systemic hypertensive heart disease possible outcomes

Answer 8

normal longevity
progressive ischemic heart disease
progressive renal damage
stroke
progressive heart failure
sudden cardiac death

Question 9

effects of systemic hypertensive heart disease on brain

Answer 9

cerebral vessels affected by arteriolosclerosis are weakane and more likely to rupture, causing intracerebral hemorrhage

infarcts

hypertensive encephalopathy (headaches, confusion, vomiting, convulsions)

Question 10

systemic hypertensive heart disease effects on kidney

Answer 10

benign HTN (gradual)-common in older pts. kidneys usually atrophic. granular, pitted surfaces. hyaline arteriolosclerosis of vessels results in ischemia and atrophy. glomeruli may become sclerosed.

in malignant HTN-see pinpoint petechial hemorrhages on surface. fibrinoid necrosis of arterioles. hyperplastic arteriolosclerosis and microthrombi lead to global ischemia.

Question 11

cor pulmonale

Answer 11

pulmonary hypertensive heart disease

Question 12

causes of cor pulmonale

Answer 12

acute-massive pulmonary embolism, resulting in RV dilatation w/o hypertrophy (b/c hypertrophy takes TIME)

chronic-caused by primary pulmonary or secondary pulmonary HTN due to chronic lung diseases. you see RV hypertrophy.

Question 13

CHF pathogenesis

Answer 13

usually fromt a slowly developing intrinsic deficit in contraction (but occasionally can be acute)

mechanisms:

• abnormal load presented to heart
• impaired ventricular filling
• osbruction due to valve stenosis

Question 14

compensatory mechanisms for CHF-acute

Answer 14

frank starling mechanism

activation of neurohumoral (NE, renin angiotensin aldosterone, release of ANP for atrium)

Question 15

compensatory mechanisms for CHF-non acute

Answer 15

cardiac hypertrophy

Question 16

what kinds of hypertrophy are there for the cardiac muscle?

Answer 16

pressure overload-causing concentric hypertrophy (HTN, aortic stenosis)

volume overload-causing eccentric hypertrophy. hypertrophy accompanied by dilatation (mitral or aortic regurg)

Question 17

left ventricular hypertrophy is an independent risk factor for sudden death: true of false?

Answer 17

true

Question 18

heart failure cells

Answer 18

hemosiderin laden macrophages that you see in pulmonary edema

Question 19

prerenal azotemia

Answer 19

impaired kidney fxn due to severe perfusion deficit. can occur with left sided heart failure that results in severe perfusion deficit.

Question 20

how does R sided heart failure occur USUALLY?

Answer 20

secondary to left sided failure

Question 21

when you have an obstruction, ventricles respond by?

Answer 21

acutely-dilatation

chronic-hypertrophy

Question 22

azotemia is more significiant with which sided heart failure?

Answer 22

right sided