HTN and Arteriosclerosis

Question 1

Normal BP is considered:

Answer 1

• Systolic < 120 mmHg
• Diastolic < 80 mmHg

Question 2

USPSTF recommends all individuals be screen for HTN at what age?

Answer 2

≥18 yo

Question 3

Malignant HTN (> 200/120 mmHg) will lead to death within how long?

Answer 3

1-2 years

Question 4

How many people with uncontrolled HTN will die due to stroke?

Answer 4

1/3

Question 5

How many with uncontrolled HTN will die due to IHD or CHD?

Answer 5

50%

Question 6

Angiotensin II is a powerful BLANK

Answer 6

vasoconstrictor

Question 7

Angiotensin II is a powerful vasoconstrictor that stimulates the release of BLANK

Answer 7

Aldosterone –> increased blood volume and blood pressure

Question 8

The pulmonary and renal endothelium release ACE which functions to do what?

Answer 8

Converts angiotensin I to angiotensin II

Question 9

What does the liver secrete to facilitate RAAS?

Answer 9

Angiotensinogen

Question 10

What results in the transformation of angiotensinogen to angiotensin I?

Answer 10

Renin

Question 11

What are the important effects of angiotensin II resulting in an increase in BP?

Answer 11

• SANS activity
• Tubular NaCl reabsorption & H2O retention
• Adrenal gland stimulation to secrete aldosterone (leads to the above)
• Arteriolar vasoconstriction
• Pituitary gland stimulation leading to ADH secretion increasing H2O retention

Question 12

H2O and Na retention stimulate which cells for negative feedback on the RAAS?

Answer 12

Juxtaglomerular cells

Question 13

Primary HTN occurs in what percentage of cases?

Answer 13

95%

Question 14

What characteristic of arteries is changed during aging that enhances risk for HTN development?

Answer 14

Increased stiffness and less compliance due to a decrease in elasticity

Question 15

What are the disorders (categories) of secondary HTN?

Answer 15

ABCDEF
* Aldosterone
* Bad kidneys
* Catecholamines, coarctation of aorta, Cushing’s syndrome
* Drugs: methamphetamines, cocaine, NSAIDs, corticosteroids, oral contraceptives (high doses of estrogens)
* Erythropoietin & Endocrine disorders (hypothyroidism, hyperthyroidism, hyperparathyroidism)
* Food

Question 16

What is the function of aldosterone? How can it increase the risk of secondary HTN?

Answer 16

• Na reabsorption from tubular urine back into bloodstream
• Increased blood volume increases BP
• K secretion into tubule

Idiopathic hyperaldosteronism or adenoma

Question 17

What can cause HTN with hypokalemia?

Answer 17

Hyperaldosteronism

Question 18

What is renovascular HTN?

Answer 18

HTN resulting from compromised arterial supply to the kidneys
* Decrease in stretch of juxtaglomerular apparatus leading to release of renin

Question 19

Fibromuscular dysplasia (FMD) occurs most commonly in which gender?

Answer 19

females (90%)

Question 20

Fibromuscular dysplasia (FMD) has multiple areas displaying what?

Answer 20

Stenosis then dilation (string of beads)

Question 21

T/F: Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic process that most commonly involves the renal arteries

Answer 21

True, renal arteries (75-80%) of time

Question 22

How often are extracranial cerebrovascular arteries involved in fibromuscular dysplasia (FMD)?

Answer 22

75% of time

Question 23

Hyperplasia of what structures leads to lumenal stenosis in fibromuscular dysplasia (FMD)?

Answer 23

• Tunica media
• Tunica intima

Question 24

What are the (4) Ps of HTN-associated arteriosclerosis?

Answer 24

• Pink (hyaline deposition)
• Plasma proteins
• Pressure (HTN) & DM
• Pinpoint lumen or Packed lumen

Question 25

What is the pathogenesis of HTN-associated arteriosclerosis?

Answer 25

* Leakage of plasma components across injured endothelial cells into vessel wall * Increased **ECM** due to **smooth muscle** stimulation * **lumenal narrowing**

Question 26

An **onion skin** appearance of vessels is noted in what type of arteriosclerosis?

Answer 26

Hyperplastic ateriosclerosis (HTN associated)

Question 27

**Malignant HTN** is associated with what type of necrosis?

Answer 27

Fibrinoid necrosis

Question 28

What is hyaline arteriosclerosis?

Answer 28

A form of arterial thickening and hardening as a result of hypertension

Question 29

What happens to the **LV** due to **HTN**?

Answer 29

Concentric LV hypertrophy

Question 30

How does **HTN** lead to **nephrosclerosis**?

Answer 30

* Benign: **hyaline deposition** leading to **media** and **intima** thickening and **narrowed lumen** * Results in ischemia and **atrophy** * Renal function **maintained** * Malignant: **Fibrinoid necrosis** and **hyperplastic arteriosclerosis** * Renal function is **not maintained**

Question 31

**Papilledema** is a sign of which type of **HTN retinopathy**?

Answer 31

Severe

Question 32

**Cotton-wool spots** is a sign of what type of **HTN retinopathy**?

Answer 32

Moderate

Question 33

**Arteriovenous nicking** is a sign of what type of **HTN retinopathy**?

Answer 33

Mild

Question 34

**Aortic dissection** occurs when?

Answer 34

Blood separates the **tunica media**

Question 35

What are some predisposing factors to **aortic dissection**?

Answer 35

* HTN, M, 40-60 yo (90%) * Marfan syndrome or Ehlers Danlos * Trauma * Vasculitis * Use of **cocaine** * **intima tear**

Question 36

Where does a **Type A aortic dissection** take place?

Answer 36

Affects **ascending aorta**

Question 37

Where does a **type B aortic dissection** take place?

Answer 37

Begins beyond the **subclavian artery**

Question 38

Pain from **aortic dissection** can **radiate** to?

Answer 38

Back

Question 39

How do **calcium salts** appear on **H&E**?

Answer 39

Dark blue

Question 40

T/F: In **Monckeberg medial calcific sclerosis** the lumen is significantly narrowed

Answer 40

False