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Pathology 1 - Hypertension Flashcards

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1
Q

Normal Blood Pressure Value

A

<130/85

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2
Q

High Blood Pressure Value

A

> 140/90

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3
Q

Stages of Hypertension

A

Mild: +20
Moderate: +40
Severe: +80
Malignant: >210/120

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4
Q

Two main factors that regulate BP

A
  1. Cardiac Output -> systolic
  2. Peripheral Resistance -> diastolic
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5
Q

Types of Hypertension

A
  1. Essential Hypertension
  2. Secondary Hypertension
  3. Accelerated/Malignant
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6
Q

Essential Hypertension Criteria

A

95% of cases
idiopathic
key initiating factor: low renal Na excretion
reversible if managed

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7
Q

Etiology of Essential HTN

A

Environmental
Genetic
Increased blood volume
Increased peripheral resistance

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8
Q

Most common of Essential HTN

A

Hyperinsulinemia

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9
Q

Secondary Hypertension Criteria

A

Secondary to pre-existing illness
eg. renal, endocrine, cardiovascular, neurologic

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10
Q

Most common renal causes of 2nd HTN

A

CKD/GN, RAS, Renin/Aldosterone- producing tumours

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11
Q

Most common endocrine causes of 2nd HTN

A

Cushing, CAH, Thyrotoxicosis, Myxoedema, Pheochromocytoma, OCP

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12
Q

Most common vascular causes of 2nd HTN

A

Coarctation of aorta, PAN, aortic insufficiency

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13
Q

Most common neurogenic causes of 2nd HTN

A

Psychogenic, increased intracranial pressure, polyneuritis

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14
Q

Pathogenesis of Renovovascular HTN

A

decreased GFR
Renin stimulation by JGA
Renin will cause:
1. Aldosterone -> Na retention -> increased blood volume
2. Angiotensin II -> vasoconstriction -> increased peripheral resistance

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15
Q

Malignant HTN Criteria

A

Sudden/Sustained diastalic BP >120 mmHg
Associated with end stage organ damage
Progressive and fatal

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16
Q

Factors which can complicate HTN

A
  • Arterial necrosis with thrombosis
  • Rapidly developing renal failure
  • Hypertensive encephalopathy (papilledema)
  • Left ventricular failure
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17
Q

What causes histopathological and tissue changes in HTN

A

arteriolopathy (pathological changes in arteriolar wall

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18
Q

What are the histopathological and tissue changes in HTN

A
  • Thickening of 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 of the arterioles
  • Thrombosis of the lumen of the arterioles
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19
Q

What 2 main things will the arteriole changes lead to

A
  1. Ischemia
  2. Hemorrhage
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20
Q

Pathophysiology of ischemic infarction

A
  1. atherosclerosis/smooth muscle hypertrophy
  2. narrowing of bv
  3. no oxygen supply
  4. tissue infarction healed by scarring
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21
Q

Example of ischemic infarction

A
  • Hypertensive nephropathy
  • Ischemic heart disease
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22
Q

Pathophysiology of hemorrhage

A
  1. Thin/abnormally dilated vessel wall
  2. Aneurysm
  3. Rupture in brain/retina
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23
Q

Effect of HTN on large BV

A

Macroangiopahy
Atherosclerosis and its complications
causes structural changes that potentiate AD & CVA

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24
Q

Effect of HTN on small BV

A

Hyaline and Hyperplastic arteriosclerosis

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25
Definition of Hyaline Arteriosclerosis
Homogenous pink hyaline thickening of the arteriole wall Loss of underlying structural details and narrowing of the lumen
26
Demographic of Hyaline Arteriosclerosis
- Old patients - Hypertensive patients (severe hyaline change) - Diabetic patient (diabetic microangiopathy)
27
Pathogenesis of Hyaline Arteriosclerosis
- HTN leads to leakage of plasma proteins - bind to endothelial layer - excess extracellular matrix is formed by smooth muscle cells - benign
28
Where does Hyaline Arteriosclerosis occur
- benign nephrosclerosis - arterial narrowing -> impaired renal blood flow w/loss of nephrons
29
Hyaline Arteriosclerosis
30
Definition of Hyperplastic Arteriosclerosis
- laminations of smooth muscle cells with thickening and proliferation of the basement membrane - onion skin appearance - malignant
31
Demographic of Hyperplastic Arteriosclerosis
malignant hypertension (diastolic >120)
32
Complication of Hyperplastic Arteriosclerosis
Cerebral and renal injury
33
Presentation of Hyperplastic Arteriosclerosis in patient with malignant HTN
accompanied by fibrinoid deposits and necrotizing arteriolitis (vessel wall necrosis)
34
Hyperplastic Arteriosclerosis
35
Necrotizing arteriole - Necrosis = rough surface =blood cant move smoothly = thrombosis
36
Effect of HTN on heart
LVH, Hypertensive cardiomyopathy (CAD, HF, CA) -> IHC/MI
37
Effect of HTN on kidney
benign nephrosclerosis
38
Effect of HTN on eyes
Hypertensive retinopathy
39
Effect of HTN on brain
intracerebral hemorrhage, lacunar infarcts, hypertensive encephelopathy
40
How does HTN predispose to ventricular hypertrophy
increased vascular resistance
41
How does HTN predispose to ventricular hypertrophy
increased vascular resistance vessels narrow myocardium needs to work harder to pump blood ventricle thickens
42
Describe the presentation of left ventricular hypertrophy
concentric and diffuse hypertrophy (not focal)
43
Define Aortic Dissection
Tear in the wall that causes blood to flow between the layers of the wall of the aorta and forces the wall appart
44
Consequence of Aortic Dissection
Medical emergency Complete tear -> massive and rapid blood loss 90% mortality
45
Etiology of Aortic Dissection
Hypertension (70-80%) Connective tissue disorders (Marfan - 5-9%, proximal dissection, Turner - aortic root dilation) Vasculitis (rare) Chest trauma (blunt chest trauma, latrogenic - cardiac catherization, intra-aortic balloon pump)
46
Pathogenesis of aortic dissection
lumen narrowed by dissection causes a balloon of blood that will eventually rupture thoracic cavity will be filled with blood
47
Type of Aortic Dissection
- Type A: Aorta - Type B: subclavian artery
48
What type of Hypertensive Nephropathy is found in Benign HTN
- Hyaline arteriosclerosis - Consequent ischemia - Tubular atrophy, interstitial fibrosis, sclerosis of glomeruli - Subscapular scars (granular surface and contracted kidney) - Renal failure
49
What type of Hypertensive Nephropathy is found in Malignant HTN
- Acute renal failure - Papilledema - Encephalopathy - Heart failure
50
Pathogenesis of Hypertensive Nephropathy is found in Malignant HTN
severe increase in BP -> - endothelial injury - thrombosis - intravascular coagulation = ischemia
51
Phases of Hypertensive Nephropathy is found in Malignant HTN
Acute: fibrinoid necrosis of vessel wall, intravascular thrombosis Chronic: hyperplastic arteriosclerosis, ischemic glomerular sclerosis
52
Nephrosclerosis
- typical appearance of HTN - leathery granularity due to minute scarring - hyalinization/hyperplasia of capillaries -> pinpoint necrosis -fibrosis in certain areas
53
Chronic pyelonephritis
coarse granularity due to inflammation healed by fibrosis
54
-nephrosclerosis - narrowed blood vessels - dead areas and viable areas
55
nephrosclerosis
56
2 types of cerebral hemorrhage
1. intracerebral 2. subarachnoid
57
intracerebral hemorrhage with extension to the venticular system
58
intracerebral hemorrhage with extension to the ventricular system
59
sub arachnoid hemorrhage (cerebral blood vessels) - thin walled -end arteries - cong. aneurisms
60
2 Types of brain infarction in HTN
1. Ischemic infarction 2. Hemorrhagic infarction
61
area surrounding the hemorrhage will be nechrotic due to low/no oxygen supply
62
2 types of ischemic infarcts
1. lacunar infarcts 2. cerebral infarcts
63
what are infarcts
arteriolar occlusion of deep penetrating arterioles of pons most common in basal ganglia, deep white matter and brain stem
64
lacunes - single or multiple cavitary infarcts
65
cerebral infarction - due to ischemia as a result of hyaline arteriosclerosis
66
lacunar infarct cystic space from the resolved liquefactive necrosis hemosiderin may be present from hemorrhage
67
Renal causes of hypertension (6)
- Renal artery stenosis (atherosclerosis, fibromuscular dysplasia) - Polycystic disease - Glomerulonephritis (acute/chronic) - Renal vasculitis (SLE) - Renin producing tumours (reninoma) - Catecholamine producing tumour (pheochromocytoma)
68
Presentation of hypertensive retinopathy (4)
- arteriosclerosis causes arteriole light reflex to become broad and dull (silver wire) - generalized or focal retinal arteriolar constriction (pale) - small flame-shaped hemorrhage - Small white foci of retinal ischemia (cotton wool spots) - Yellow hard exudates, due to lipid deposition
69
Staes of hypertensive retinopathy
Grade 1: thickening of arterioles Grade 2: focal arteriolar spasms, vein constriction, AV nipping Grade 3: hemorrhages , dot-blot and cotton wool, hard waxy exudates grade 4: papilloedema
70
- Disc edema with HTN - splinter hemorrhages

CVS Pathology (7 decks)

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