Cardiovascular Pathology Flashcards
(50 cards)
1
Q
What is considered malignant hypertension?
A
BP of 200/120 with end organ damage (retinopathy)
2
Q
how does malignant hypertension cause retinopathy?
A
- HTN -> increase hydrostatic pressure -> delicate retino blood vessels - > damage arterioles & leakage into retina area -> retinopathy
3
Q
Hypertensive Encephalopathy
A
- Severe HTN -> lethargy, seizures, cortical blindness, and coma
- lethargy occurs due to the damage of organs
- seizures and coma due to damage of brain
- Cortical blindness due to retinopathy
4
Q
Hypertensive thrombotic Microangiopathy
A
- increase HTN -> hemolysis -> thrombocytopenia
- due to vascular wall damage -> clotting
5
Q
What are two complications associated with HTN and atherosclerosis?
A
kidney -> renal failure, nephrosclerosis
Heart -> LVF, Ischemic heart disease
6
Q
How does HTN affect the blood vessels?
A
- Accelerate Atherosclerosis
- Degenerative changes in M/L arteries (damage)
- Small vessel changes such as hyaline arteriosclerosis and hyperplastic arteriolosclerosis
7
Q
Hyaline Arteriolosclerosis
A
Chronic HTN-> hemodynamic stress -> plasma protein leakage and SM matrix production -> deposits of pink hyaline -> thickening of walls -> narrowing lumen of vessel -> impairment of blood flow and ischemic changes.
8
Q
Hyperplastic Arteriolosclerosis
A
Sudden increase in BP (malignant) -> thickening of Basement membrane (PAS positive) -> smooth cell hyperplasia -> concentric lamination “onion skin” with luminal narrowing -> accompanied by fibrinoid necrosis -> organ BV is supplying will have decrase BF and begin necrosis.
9
Q
How is the kidney affected by HTN?
A
- Hyaline Arteriolosclerosis -> benign
- Hyperplastic arteriolosclerosis -> necrosis -> malignant nephrosclerosis
10
Q
How does HTN affect the brain?
A
Hyaline & Hyperplastic arteriolosclerosis can cause intraparenchymal hemorrhages.
11
Q
How does HTN affect the retina?
A
hyperplastic arteriolosclerosis -> cotton wool spots
due to infarct.
12
Q
What is pulmonary HTN?
A
- high BP in BV carrying supply to lungs
13
Q
When do we see pulmonary HTN?
A
Heart Failure, Congenital heart disease, valvular disorders, lung diseases
14
Q
What changes in BV would be see in pulmonary HTN?
A
- Fibrotic intimal thickening
- medial hyperplasia
15
Q
Systemic Left Sided hypertensive heart disease
A
- Left ventricular hypertrophy w/o other CVD
- Hx of HTN in over organs
- HTN -> LVH -> Ischemic Heart Disease -> LVF
16
Q
Isolated Pulmonary Right sided HTN heart disease
A
- AKA “Cor Pulmonale”
- RV and RA hypertrophy
- Pulmonary HTN -> RVF due to back presssure -> Cor pulmonale
17
Q
what causes Acute Cor Pulmonale?
A
- Massive pulmonary embolism -> RV dilated but no hypertrophy
18
Q
what causes Chronic Acute Pulmonale?
A
- COPD
- pulmonary fibrosis, cystic fibrosis, obesity
- RV hypertrophy, RA hypertrophy w/ dilation
19
Q
What are causes for secondary HTN?
A
- renal -> Glomerulonephritis, Renal Artery Stenosis
- Endocrine -> Cushing disease, OCP, thyrotoxicosis
- Vascular -> Coarctation of aorta, polyarteritis nodosa, aortic insufficiency
- Neurogenic -> intracranial pressure, Polyneuritis
20
Q
What is an aneurysm?
A
- abnormal dilation of an artery of heart
21
Q
How do we classify an aneurysm?
A
- True involves all the layers of the vessel
- can be either saccular or fusiform
- False is a defect in the wall -> hematoma takes place in extravascular place. “pulsating hematoma”
22
Q
What are common causes of Aneurysms?
A
- Atherosclerotic
- Syphilitic
- Mycotic
- Vasculitic
- Congenital
- Iatrogenic
23
Q
Pathogenesis of Aneurysms
A
- Dysfunctional CT synthesis + CT degradation -> loss of SMC
- “cystic medial degeneration”
- loss of SMC and loss of elastic fibers -> loose walls -> bubble -> aneurysm
24
Q
Abdominal Aortic Aneurysm
A
- Atherosclerotic plaques that cause ischemia of the inner media
- the plaques increase the absorption distance leading to decrease BF
- creates thinner walls
25
Ascending Aortic Aneurysm
- HTN causes narrowing of lumen of Vasa Vasorum
- Ischemia of outer media
- leads to loss of SMC and aortic degeneration
26
Cystic medial degeneration
- increase in destoryed elastin
- also areas with no elastin, resemble cystic spaces
27
Signs & Symptoms of AAA
- Most likely male
- Above 50 usually
- Smokers
- discovered as a abdominal mass stimulating a tumor
- Ruptures into peritoneal cavity or retroperitoneal tissue; possibly fatal
- obstruction will cause downstream tissue ischemia injury
28
What is seen in the tertiary stage of syphillis?
Aortitis
29
What is pathogenesis of syphilitic Aneurysm?
Spirochete -> inflammatory response -> obliterative endarteritis of vasa vasorum in aorta -> narrowing of VV lumen -> ischemic injury to elastic tunica in aorta -> media destruction and weakening -> chronic inflammation, scarring
* obliterative endarteritis is inflammation of inner lining of BV causing obstruction
30
What structural changes occur in syphilitic Aneurysms?
- Chronic inflammation -> fibrosis -> tree bark appearance -> wrinkling can occur due to atherosclerosis, lead to narrowing of coronary ostia -> aortic valve dilation -> valve insufficiency -> hypertrophy of left ventricle -> Cor Bovinum "Cow heart"
31
Where does a syphilitic Aneurysm usually take place?
Thoracic aorta
32
Where do Aneurysms due to Marfans syndrome usually take place?
Ascending Aorta or arch of aorta due to the highest pressure and decrease of elastic tissue in area
33
What is mutation and inheritance of Marfans syndrome?
Autosomal Dominant
Fibrillin 1 mutation
34
What is etiopathogenesis of aneurysm due to marfan syndrome?
- decrease in fibrillin-1 ->incompetent elastic fibers -> aneurysms, aortic dissection, valve lesions
35
what are skeletal abnormalities of Marfan's patients?
- elongated axial bones
- lower body is longer
- long thin extremities
- ocular ciliary body is rich in fibrillin resulting in subluxation
36
Where are Berry aneurysms located?
Circle of Willis -> Anterior Cerebral Artery
37
What is the genetic mutation associated with Berry Aneuryms?
Autosomal dominant polycystic kidney disease
38
Pathogenesis of Berry Aneurysm
- the arterial media is weakened at birth already, but no aneurysm is present
- clinically silent until ruptured
- can rupture whenever but usually during increased cranial pressure (orgasm or stool straining) -> subarachnoid hemorrhage -> severe headache, coma
39
What is a mycotic aneurysm?
- Not true aneurysm
- Weakened and ruptured vessel wall due to microbial infection
40
Pathogenesis of mycotic aneurysm
dislodged septic embolism -> *causes BV wall damage -> causes rupture -> hemorrhage and abscess at site
* due to infective endocarditis, which is bacterial infection of BV or heart or valve
- small and clinically silent
- mycotic is a misnomer bc they thought it was initially by a fungal infection
41
What is an Aortic Dissection?
- is a false aneurysm
- seperation of the layers of media due to weakening from blood filled channels within the aorta
- between the middle and outer third of aortic wall
42
who is most susceptible to an aortic dissection?
- males
- 40-60 years old
- antecedent hypertension
- younger patients with syndromic diseases (marfans)
43
Pathogenesis of Aortic Dissection
- Hypertension
- Marfans or Ehler Danlos
44
How are Aortic dissections classified?
DeBakey Classification (I, II, or III)
45
Type A Dissections, proximal lesion, Debakey 1/2
- More common in ascending aorta
- high mortality
- need rapid treatment
46
Type B Dissections, distal lesions, Debakey 3
- Descending aorta distal to left subclavian artery
- can be managed conservatively
47
What are clinical symptoms of Aortic dissection?
- sudden excruciating pain
- starts in anterior chest
- radiating to back between scapulae
- absent weak pulse
- confused with MI
48
What is the most common cause of death from a aortic dissection?
rupture and bleeding into the pericardial, pleural, or peritoneal cavities
49
Complications with Aortic dissection
- retrograde dissection into aortic root->disrupts aortic valve
- cardiac tamponade or aortic insufficiency -> with blood
- extension into great arteries of neck or various other arteries -> vascular obstruction -> ischemia
- EX: if dissection reaches coronary arteries -> MI or dissection reaches spinal arteries transverse myelitis
50
What is a Double barreled Aorta?
When a dissecting hematoma reenters the lumen of aorta through a second distal intimal tear, this creates a second vascular channel within the media
This channel becomes endothelialized forming a chronic dissection
